3D打印皮外导板辅助微创椎弓根螺钉植入治疗多节段胸腰椎骨折  

Three-dimensional printed drill guide template assisting percutaneous pedicle screw fixation for multiple-level thoracolumbar fractures

作　　者：曾柏方 吴超 李涛[2] 王翔宇[2] 尚庆 ZENG Baifang;WU Chao;LI Tao;WANG Xiangyu;SHANG Qing(Department of Spine Surgery,Affiliated Hospital of Southwest Medical University,Luzhou Sichuan,646000,P.R.China;Department of Spine and Traumatology Surgery,Zigong Fourth People's Hospital,Zigong Sichuan,643000,P.R.China;Department of Spine Surgery,Fushun People's Hospital,Fushun Sichuan,643200,P.R.China)

机构地区：[1]西南医科大学附属医院脊柱外科,四川泸州646000 [2]自贡市第四人民医院脊柱与创伤外科,四川自贡643000 [3]富顺县人民医院脊柱外科,四川富顺643200

出　　处：《中国修复重建外科杂志》2021年第6期742-749,共8页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：四川省重点科技计划项目(2016JY0108);四川省卫生和计划生育会员会科研课题(17PJ144);自贡市重点科技计划项目(2019ZC01)。

摘　　要：目的评价3D打印皮外导板辅助经皮椎弓根螺钉植入治疗多节段胸腰椎骨折的可行性和安全性。方法回顾分析2017年5月—2019年1月手术治疗的19例无神经损伤多节段胸腰椎骨折患者临床资料。其中男9例,女10例;年龄22~63岁,平均43.6岁。致伤原因:交通事故伤12例,高处坠落伤7例。骨折椎体涉及T10~L3共40个,单个椎体骨折按AO分型:A1型29个,A2型9个,A3型2个;多节段胸腰椎骨折按唐三元分型:ⅠA型17例,ⅠB型1例,ⅡC型1例。受伤至手术时间2~6 d,平均3.1 d。术中采用3D打印皮外导板辅助经皮椎弓根螺钉植入。记录术中出血量、平均每枚螺钉植入手术时间和透射次数;术前、术后3 d及末次随访时采用疼痛视觉模拟评分(VAS)评价腰痛改善情况。根据术后3 d CT采用Gertzbein和Robbins量表评价植钉准确性(A、B级为植钉准确,A级为植钉优秀),测量骨折节段矢状面Cobb角,计算伤椎前缘高度百分比;测量术后双侧椎弓根螺钉内倾角差值,分析其一致性,并与术中选用皮外导板的角度进行对比,以验证皮外导板控制内倾角的有效性。结果 19例患者均顺利完成手术,术中出血量44~67 mL,平均54.3 mL;平均每枚螺钉植入手术时间7.3~11.1 min,平均9.6 min;平均每枚螺钉植入透射次数1.6~2.5次,平均2.0次。无脊髓、神经根损伤及感染等并发症发生。患者均获随访,随访时间24~38个月,平均28.7个月。采用Gertzbein和Robbins量表评价植钉准确性:A级145枚,B级11枚;植钉准确率达100%,优秀率92.9%。术后3 d CT测量示同椎体左、右侧螺钉内倾角差异无统计学意义(t=0.93,P=0.36);术中选用皮外导板的内倾角与螺钉内倾角比较差异均无统计学意义(P>0.05)。患者术后3 d与末次随访时腰痛VAS评分、矢状面Cobb角及伤椎前缘高度百分比均较术前显著改善,末次随访时腰痛VAS评分较术后3 d进一步改善(P<0.05);术后两时间点间矢状面Cobb角及伤椎前缘高度�Objective To evaluate the feasibility and safety of three-dimensional(3D) printed drill guide template-assisted percutaneous pedicle screw fixation for multiple-level thoracolumbar fractures. Methods Clinical data of 19 patients with multilevel thoracolumbar fracture without nerve injury who underwent surgical treatment between May 2017 and January 2019 were retrospectively analyzed. There were 9 males and 10 females and their age ranged from 22 to 63 years, with an average age of 43.6 years. Injury cause included traffic accident injury in 12 cases, and fall from height injury in 7 cases. A total of 40 fractured vertebrae were involved in T10 to L3 levels. According to AO classification,there were 29 fractures of type A1, 9 fractures of type A2, and 2 fractures of type A3. According to TANG Sanyuan classification, multiple-segment thoracolumbar fractures were classified as 17 cases of type ⅠA, 1 case of type ⅠB, and1 case of type ⅡC. The time from injury to operation was 2-6 days, with an average of 3.1 days. The 3 D-printed universal drill guide template was used for assisting percutaneous pedicle screw fixation during operation. Intraoperative blood loss,average operation time and fluoroscopy frequency of each screw were recorded. Visual analogue scale(VAS) score was used to evaluate the improvement of low back pain before operation, at 3 days after operation, and at last follow-up.According to the CT at 3 days after operation, the Gertzbein and Robbins scales were used to evaluate the accuracy of screw insertion(the grade A and grade B were regarded as accuracy, the grade A was regarded as excellent of screw insertion). The Cobb angle in sagittal plane of the fracture segment was measured, and the percentage of anterior edge of injured vertebral height was calculated. The consistency of the inclination of bilateral pedicle screws were analyzed postoperatively, and compared the angle of the intraoperative guide plate with the inclination of screw to verify the effectiveness of the guide plate in controll

关 键 词：多节段胸腰椎骨折 皮外导板 3D打印 椎弓根螺钉 微创手术 

分 类 号：R687.3[医药卫生—骨科学]