3D打印技术在老年退变性腰椎侧弯手术中的应用
|
摘要
目的:探讨3D打印技术应用于老年退变性腰椎侧弯手术的效果和可行性。方法:回顾性分析40例老年退变性腰椎侧弯患者的资料,其中20例采取常规腰椎后路减压植骨融合椎弓根螺钉内固定侧弯纠正术(对照组),20例采取联合3D打印腰椎模型和术中椎弓根定位-定向导板的后路减压植骨融合椎弓根螺钉内固定侧弯纠正术(研究组)。比较两组手术时间、术中出血量、术中C臂机透视次数,术前与术后6个月VAS、ODI评分的差值,Kawaguchi法评价椎弓根螺钉置钉准确性。结果:对照组和研究组手术时间分别为(240. 5±40. 1)、(210. 3±30. 6)min,术中出血量分别为(910. 1±92. 3)、(720. 9±86. 1) m L,术中C臂机透视次数分别为(18. 5±3. 5)、(8. 5±1. 4)次,置钉0级率分别为91. 9%(193/210)和98. 1%(212/216),两组间以上指标差异均有统计学意义(P <0. 05)。术前及术后6个月时两组VAS评分及ODI评分的差值差异均无统计学意义(P> 0. 05)。两组病例均获骨性融合,均未出现神经症状,也未见内固定装置松动、断裂等并发症。结论:3D打印腰椎模型及椎弓根导板可以提高老年退变性腰椎侧弯患者手术椎弓根螺钉置入的精确性,节约手术时间,减少术中出血及术中C臂机透视次数,值得推荐使用。
Aim: To investigate the efficacy and feasibility of 3 D printing in the surgery of the elderly patients with degenerative lumbar scoliosis. Methods: Data of 40 cases of degenerative lumbar scoliosis who had undergone surgery were retrospectively analyzed. Twenty patients underwent the surgery of routine lumbar posterior pedicle screw fixation and bone graft fusion for correcting scoliosis( control group). The other 20 patients underwent the surgery of lumbar posterior pedicle screw fixation and bone graft fusion for correcting scoliosis combining 3 D printing of the lumbar spine model and the pedicle guide plate( study group). The operation time,blood loss,intraoperative C-arm fluoroscopy frequency,the difference of postoperative visual analog scale( VAS),Oswestry disability index( ODI) between preoperation and after operation for 6 months,and pedicle screw position accuracy between the 2 groups were compared. Results: The operation time of the control group and the study group was respectively( 240. 5 ± 40. 1),( 210. 3 ± 30. 6) min,the blood loss during the operation was respectively( 910. 1 ± 92. 3),( 720. 9 ± 86. 1) m L,the intraoperative C-arm fluoroscopy frequency was respectively( 18. 5 ± 3. 5),( 8. 5 ± 1. 4) times,the rate of placing nail 0 with Kawaguchi evaluation method was respectively 91. 9%( 193/210),98. 1%( 212/216),and there were significant differences; the difference of VAS scores and ODI scores between preoperation and after operation for 6 months of the 2 groups had no significant differences( P > 0. 05). Bone graft was completely fused in both groups,no neurological symptoms or complications such as loosening and rupture of internal fixation were observed. Conclusion: 3 D printing lumbar spine model and pedicle guide plate can improve the accuracy of pedicle screw placement,save operation time,and reduce operative blood loss and the number of intraoperative C-arm fluoroscopy,so it is worth recommending.
Aim: To investigate the efficacy and feasibility of 3 D printing in the surgery of the elderly patients with degenerative lumbar scoliosis. Methods: Data of 40 cases of degenerative lumbar scoliosis who had undergone surgery were retrospectively analyzed. Twenty patients underwent the surgery of routine lumbar posterior pedicle screw fixation and bone graft fusion for correcting scoliosis( control group). The other 20 patients underwent the surgery of lumbar posterior pedicle screw fixation and bone graft fusion for correcting scoliosis combining 3 D printing of the lumbar spine model and the pedicle guide plate( study group). The operation time,blood loss,intraoperative C-arm fluoroscopy frequency,the difference of postoperative visual analog scale( VAS),Oswestry disability index( ODI) between preoperation and after operation for 6 months,and pedicle screw position accuracy between the 2 groups were compared. Results: The operation time of the control group and the study group was respectively( 240. 5 ± 40. 1),( 210. 3 ± 30. 6) min,the blood loss during the operation was respectively( 910. 1 ± 92. 3),( 720. 9 ± 86. 1) m L,the intraoperative C-arm fluoroscopy frequency was respectively( 18. 5 ± 3. 5),( 8. 5 ± 1. 4) times,the rate of placing nail 0 with Kawaguchi evaluation method was respectively 91. 9%( 193/210),98. 1%( 212/216),and there were significant differences; the difference of VAS scores and ODI scores between preoperation and after operation for 6 months of the 2 groups had no significant differences( P > 0. 05). Bone graft was completely fused in both groups,no neurological symptoms or complications such as loosening and rupture of internal fixation were observed. Conclusion: 3 D printing lumbar spine model and pedicle guide plate can improve the accuracy of pedicle screw placement,save operation time,and reduce operative blood loss and the number of intraoperative C-arm fluoroscopy,so it is worth recommending.
引文
[1] PETZOLD R,ZEILHOFER HF,KALENDER WA. Rapid protyping technology in medicine:basics and applications[J]. Comput Med Imaging Graph,1999,23(5):277
[2]陈鸿奋,赵辉,王富明,等.髋臼后部骨折顺行拉力螺钉固定进钉导航模板的可行性研究[J].中华骨科杂志,2013,33(5):514
[3]张元智,裴国献,陆声,等.计算机辅助确定下肢机械轴线在全膝关节置换术中的应用[J].中华骨科杂志,2013,33(12):1196
[4]胡勇,袁振山,谢辉,等.快速成型导向模板辅助下寰枢椎椎弓根螺钉置钉的偏差因素分析[J].中华医学杂志,2013,93(33):2659
[5] FAIRBANK JC,PYNSENT PB. The Oswestry disability index[J]. Spine,2000,25(22):2940
[6] KAWAGUCHI Y,NAKANO M,YASUDA T,et al. Development of a new technique for pedicle srew and Magerl srew insertion using a 3-dimensional image guide[J]. Spine(Phila Pa 1976),2012,37(23):1983
[7] DAFFNER SD,VACCARO AR. Adult degenerative lumbar scoliosis[J]. Am J Orthop(Belle Mead NJ),2003,32(2):77
[8]韩国嵩,马广文,黄斐,等. 3D打印技术在骨科中的研究进展[J].安徽医药,2015,19(12):2259
[9]王燎,戴尅戎.骨科个体化治疗与3D打印技术[J].医用生物力学,2014,29(3):193
[10]MASON A,PAULSEN R,BABUSKA JM,et al. The accuracy of pedicle screw placement using intraoperative image guidance systems[J]. J Neurosurg Spine,2014,20(2):196
[11]韩今华,马德春,白淼,等.腰椎椎弓根螺钉进钉点的个体化定位[J].中国组织工程研究与临床康复,2011,15(48):9066
[2]陈鸿奋,赵辉,王富明,等.髋臼后部骨折顺行拉力螺钉固定进钉导航模板的可行性研究[J].中华骨科杂志,2013,33(5):514
[3]张元智,裴国献,陆声,等.计算机辅助确定下肢机械轴线在全膝关节置换术中的应用[J].中华骨科杂志,2013,33(12):1196
[4]胡勇,袁振山,谢辉,等.快速成型导向模板辅助下寰枢椎椎弓根螺钉置钉的偏差因素分析[J].中华医学杂志,2013,93(33):2659
[5] FAIRBANK JC,PYNSENT PB. The Oswestry disability index[J]. Spine,2000,25(22):2940
[6] KAWAGUCHI Y,NAKANO M,YASUDA T,et al. Development of a new technique for pedicle srew and Magerl srew insertion using a 3-dimensional image guide[J]. Spine(Phila Pa 1976),2012,37(23):1983
[7] DAFFNER SD,VACCARO AR. Adult degenerative lumbar scoliosis[J]. Am J Orthop(Belle Mead NJ),2003,32(2):77
[8]韩国嵩,马广文,黄斐,等. 3D打印技术在骨科中的研究进展[J].安徽医药,2015,19(12):2259
[9]王燎,戴尅戎.骨科个体化治疗与3D打印技术[J].医用生物力学,2014,29(3):193
[10]MASON A,PAULSEN R,BABUSKA JM,et al. The accuracy of pedicle screw placement using intraoperative image guidance systems[J]. J Neurosurg Spine,2014,20(2):196
[11]韩今华,马德春,白淼,等.腰椎椎弓根螺钉进钉点的个体化定位[J].中国组织工程研究与临床康复,2011,15(48):9066