数字骨科3D打印技术辅助经皮椎体后凸成形术治疗OVCF的临床效果
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摘要
目的探讨数字骨科3D打印技术辅助经皮椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩性骨折(OVCF)的临床效果。方法将58例(64个伤椎)OVCF患者随机分为数字骨科3D打印技术辅助组(A组,32例)和传统手术组(B组,26例)。记录两组骨水泥注入量、手术时间、术中X射线曝光次数、VAS疼痛评分、椎体前缘恢复高度以及并发症的发生情况。结果 A、B组骨水泥注入量差异无统计学意义[(5.7±1.2) ml vs.(5.6±1.4) ml](P>0.05)。A组手术时间和术中X射线曝光次数少于B组[(36.3±8.5) min vs.(45.2±12.5) min和(4.8±2.4)次vs.(7.3±1.2)次](P<0.05),椎体前缘恢复高度和VAS疼痛评分改善程度优于B组[(7.3±1.5) mm vs.(5.6±2.1) mm和(5.7±0.8)分vs.(4.2±1.2)分](P<0.05)。A组骨水泥渗透发生率低于B组(0 vs.11.5%)(P<0.05)。结论数字骨科3D打印技术辅助PKP治疗OVCF具有手术时间短、术中透视少、恢复好和并发症少等优势。
Objective To investigate the clinical efficacy of digital orthopedics and 3 D printing-assisted percutaneous kyphoplasty(PKP) in the treatment of osteoporotic vertebral compression fracture(OVCF).Methods A total of 58 patients with OVCF was treated with digital orthopedics and 3 D printing-assisted PKP(group A,32 cases) or conventional PKP(group B,26 cases).The amount of bone cement,operation time,X-ray exposure time,VAS pain score,height of anterior vertebral body and complications were recorded.Results There was no statistical difference in the amount of bone cement between groups of A and B [(5.7±1.2) ml vs.(5.6±1.4) ml](P>0.05).Compared with group B,the operation time and X-ray exposure time were less [(36.3±8.5) minutes vs.(45.2±12.5) minutes and(4.8±2.4) times vs.(7.3±1.2) times](P<0.05),and the height of anterior vertebral body and VAS pain score were better in group A [(7.3±1.5) mm vs.(5.6±2.1) mm and(5.7±0.8) points vs.(4.2±1.2) points](P<0.05).The incidence of cement leakage in group A was lower than that in group B(0 vs.11.5%)(P<0.05).Conclusion The digital orthopedics and 3 D printing-assisted PKP in the treatment of OVCF has the advantages of shorter operation time,less X-ray exposure,better recovery and lower complications.
Objective To investigate the clinical efficacy of digital orthopedics and 3 D printing-assisted percutaneous kyphoplasty(PKP) in the treatment of osteoporotic vertebral compression fracture(OVCF).Methods A total of 58 patients with OVCF was treated with digital orthopedics and 3 D printing-assisted PKP(group A,32 cases) or conventional PKP(group B,26 cases).The amount of bone cement,operation time,X-ray exposure time,VAS pain score,height of anterior vertebral body and complications were recorded.Results There was no statistical difference in the amount of bone cement between groups of A and B [(5.7±1.2) ml vs.(5.6±1.4) ml](P>0.05).Compared with group B,the operation time and X-ray exposure time were less [(36.3±8.5) minutes vs.(45.2±12.5) minutes and(4.8±2.4) times vs.(7.3±1.2) times](P<0.05),and the height of anterior vertebral body and VAS pain score were better in group A [(7.3±1.5) mm vs.(5.6±2.1) mm and(5.7±0.8) points vs.(4.2±1.2) points](P<0.05).The incidence of cement leakage in group A was lower than that in group B(0 vs.11.5%)(P<0.05).Conclusion The digital orthopedics and 3 D printing-assisted PKP in the treatment of OVCF has the advantages of shorter operation time,less X-ray exposure,better recovery and lower complications.
引文
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[11] 李楠,张贵林,何达,等.骨水泥的分布与剂量对椎体成形术疗效影响的研究[J].中国骨与关节损伤杂志,2015,30(1):66-68.
[12] Freude T,Konig B,Martetschlager F,et al.Safe surgical technique:cement-augmented pedicle screw instrumentation and balloon-guided kyphoplasty for a lumbar burst fracture in a 97-year-old patient[J].Patient Saf Surg,2013,7:3.
[13] 汤长华,杨惠林,张晓慧,等.体外数字伤椎定位结合双探针定位椎体后凸成形术治疗T12L1压缩骨折[J].中国骨与关节损伤杂志,2014,29(11):1140-1141.
[14] 张爱明,李青,黄晖,等.CT引导结合三维重建技术在胸腰椎骨折经皮椎体成形术中的应用[J].中国骨科临床与基础研究杂志,2016,8(2):81-86.
[15] 王磊,王黎明,黄艳,等.数字化三维重建与传统经皮球囊扩张椎体后凸成形的随机对照比较[J].中国组织工程研究,2015,19(39):6360-6365.
[16] Perisinakis K,Damilakis J,Theocharopoulos N,et al.Patient exposure and associated radiation risks from fluoroscopically guided vetebroplasty or kypnoplast[J].Radiology,2004,232(3):701-707.
[17] Amoretti N,Lesbats-Jacquot V,Marcy PY,et al.Vertebroplasty and kyphoplasty under dual guidance(CT and fluoroscopy):radiation dose to radiologist.A comparative study[J].J Neuroradiol,2011,38(3):135-140.
[18] 王素春,施建东,陆爱清,等.椎基静脉孔及椎体静脉解剖在椎体成形术中的意义[J].中国临床解剖学杂志,2015,33(6):646-650.
[19] Yeom JB,Kim WJ,Choy WS,et al.Leakage of cement in percutaneous transpedicular vertebroplasty for painful osteoporotic compression fractures[J].J Bone Joint Surg Br,2003,85(1):83-89.
[20] 吴子祥,雷伟,桑宏勋,等.阶段注射法预防椎体成形术中骨水泥渗漏的实验研究[J].中国骨质疏松杂志,2010,16(2):96-99.
[21] Imai K.Analysis of vertebral bone strength,fracture pattern,and fracture location:a validation study using a computed tomography-based nonlinear finite element analysis[J].Aging Dis,2015,6(3):180-187.
[22] Liebl H,Garcia EG,Holzner F,et al.In-vivo assessment of femoral bone strength using Finite Element Analysis(FEA) based on routine MDCT imaging:a preliminary study on patients with vertebral fractures[J].PLoS One,2015,10(2):e0116907.
[2] Garfin SR,Yuan HA,Reiley MA.New technologies in spine:kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures[J].Spine(Phila Pa 1976),2001,26(14):1511-1515.
[3] Gu CN,Brinjikji W,Evans AJ,et al.Outcomes of vertebroplasty compared with kyphoplasty:a systematic review and meta-analysis[J].J Neurointerv Surg,2016,8(6):636-642.
[4] Lee ST,Chen JF.Closed reduction vertebroplasty for the treatment of osteoporotic vertebral compression fractures.Technical note[J].J Neurosurg,2004,100(4 Suppl):392-396.
[5] Liebschner MA,Rosenberg WS,Keaveny TM.Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty[J].Spine(Phila Pa 1976),2001,26(14):1547-1554.
[6] Yilmaz A,?akir M,Yüceta? C?,et al.Percutaneous kyphoplasty:is bilateral approach necessary[J]?Spine(Phila Pa 1976),2018,43(14):977-983.
[7] Yang H,Liu H,Wang S,et al.Review of percutaneous kyphoplasty in China[J].Spine(Phila Pa 1976),2016,41(Suppl 19):B52-B58.
[8] Van Meirhaeghe J,Bastian L,Boonen S,et al.A randomized trial of balloon kyphoplasty and nonsurgical management for treating acute vertebral compression fractures:vertebral body kyphosis correction and surgical parameters[J].Spine(Phila Pa 1976),2013,38(12):971-983.
[9] 文坤树,蔡勇平,张家金,等.PKP术中骨水泥的灌注量与分布对OVCF早期疗效的影响[J].重庆医学,2016,45(1):62-65.
[10] Chevalier Y,Pahr D,Charlebois M,et al.Cement distribution,volume,and compliance in vertebroplasty:some answers from an anatomy-based nonlinear finite element study[J].Spine(Phila Pa 1976),2008,33(16):1722-1730.
[11] 李楠,张贵林,何达,等.骨水泥的分布与剂量对椎体成形术疗效影响的研究[J].中国骨与关节损伤杂志,2015,30(1):66-68.
[12] Freude T,Konig B,Martetschlager F,et al.Safe surgical technique:cement-augmented pedicle screw instrumentation and balloon-guided kyphoplasty for a lumbar burst fracture in a 97-year-old patient[J].Patient Saf Surg,2013,7:3.
[13] 汤长华,杨惠林,张晓慧,等.体外数字伤椎定位结合双探针定位椎体后凸成形术治疗T12L1压缩骨折[J].中国骨与关节损伤杂志,2014,29(11):1140-1141.
[14] 张爱明,李青,黄晖,等.CT引导结合三维重建技术在胸腰椎骨折经皮椎体成形术中的应用[J].中国骨科临床与基础研究杂志,2016,8(2):81-86.
[15] 王磊,王黎明,黄艳,等.数字化三维重建与传统经皮球囊扩张椎体后凸成形的随机对照比较[J].中国组织工程研究,2015,19(39):6360-6365.
[16] Perisinakis K,Damilakis J,Theocharopoulos N,et al.Patient exposure and associated radiation risks from fluoroscopically guided vetebroplasty or kypnoplast[J].Radiology,2004,232(3):701-707.
[17] Amoretti N,Lesbats-Jacquot V,Marcy PY,et al.Vertebroplasty and kyphoplasty under dual guidance(CT and fluoroscopy):radiation dose to radiologist.A comparative study[J].J Neuroradiol,2011,38(3):135-140.
[18] 王素春,施建东,陆爱清,等.椎基静脉孔及椎体静脉解剖在椎体成形术中的意义[J].中国临床解剖学杂志,2015,33(6):646-650.
[19] Yeom JB,Kim WJ,Choy WS,et al.Leakage of cement in percutaneous transpedicular vertebroplasty for painful osteoporotic compression fractures[J].J Bone Joint Surg Br,2003,85(1):83-89.
[20] 吴子祥,雷伟,桑宏勋,等.阶段注射法预防椎体成形术中骨水泥渗漏的实验研究[J].中国骨质疏松杂志,2010,16(2):96-99.
[21] Imai K.Analysis of vertebral bone strength,fracture pattern,and fracture location:a validation study using a computed tomography-based nonlinear finite element analysis[J].Aging Dis,2015,6(3):180-187.
[22] Liebl H,Garcia EG,Holzner F,et al.In-vivo assessment of femoral bone strength using Finite Element Analysis(FEA) based on routine MDCT imaging:a preliminary study on patients with vertebral fractures[J].PLoS One,2015,10(2):e0116907.