3D打印截面模型在腰椎全椎板减压中的应用  

Application of 3D printed section model in total lamina decompression of lumbar spine

作　　者：张文玺[1] 周金华[1] 刘杰[1] Zhang Wenxi;Zhou Jinhua;Liu jie(Department of Orthopedics,People's Hospital of Liyang,Changzhou 213300,China)

机构地区：[1]江苏省溧阳市人民医院骨科,213300

出　　处：《骨科临床与研究杂志》2021年第5期295-300,306,共7页Journal Of Clinical Orthopedics And Research

基　　金：常州市卫生健康委员会重大科技项目(ZD201510,ZD201927)。

摘　　要：目的探讨3D打印截面模型结合导航模板在腰椎全椎板减压中的临床应用效果。方法纳入2018年10月至2020年10月于溧阳市人民医院骨科因腰椎退行性病变致单节段腰椎管狭窄症患者38例。依手术方式分为模型组(用3D打印截面模型结合导板辅助腰椎全椎板减压手术)和徒手组(仅参考影像资料行传统减压手术)。模型组20例,其中男8例,女12例,年龄(61.50±9.25)(47~76)岁;徒手组18例,其中男8例,女10例,年龄(65.11±9.38)(49~83)岁。其中6例合并退行性滑脱。模型组预先利用Mimics软件选择所需截面予以软件截骨,形成并打印所需3D截面模型,同时利用3-matic软件设计椎弓根定位导板,联合应用3D打印的截面模型与导板进行手术模拟,并引导手术实施。对2组术中椎板减压耗时、术中出血量、术后并发症进行比较;对2组患者术前及术后3个月疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)和日本骨科学会(JOA)评分进行评价和比较。应用SPSS 20.0软件对数据进行统计学分析。P<0.05为差异有统计学意义。结果全部患者术后随访时间为(9.10±5.34)(3~24)个月。术前与术后3个月模型组与徒手组VAS、ODI及JOA评分差异无统计学意义(均P>0.05)。2组术中椎板减压耗时和术中出血量差异均有统计学意义(均P<0.05)。2组VAS、ODI及JOA评分术前与术后纵向比较,差异均有统计学意义(均P<0.05)。术后出现并发症5例,包括脑脊液漏1例、椎间隙感染1例、肺动脉栓塞1例和切口脂肪液化2例,均经治疗后痊愈。结论利用3D打印脊柱截面模型可使椎管内结构清晰可见,利于截骨范围的精确定位;应用3D打印截面模型结合导航模板指导腰椎全椎板减压,截骨效率更高,手术出血更少。Objective To explore the clinical effect of 3D printed section model with navigation template in the decompression of lumbar vertebrae.Methods From October 2018 to October 2020,38 patients with single-segment lumbar spinal stenosis caused by degenerative spinal diseases were enrolled.All the patients were divided into model group(3D printed cross-section model combined with guide plate assisted lumbar spine decompression surgery)and freehand group(refer to image data only).Among them,8 males and 12 females were in the model group with an age of(61.50±9.25)(47-76)years,and 8 males and 10 females were in the freehand group with an age of(65.11±9.38)(49-83)years.There were 6 cases with spondylolisthesis.The required section was pre-selected in the Mimics software to perform osteotomy and form the required section model.At the same time,the pedicle positioning guide plate were designed in the 3-matic software.The 3D printed section model and the guide plate were combined for operation simulation and guiding the surgery.The operation time,intraoperative blood loss and postoperative complications of the 2 groups were compared.The visual analogue scale(VAS),Oswestry dysfunction index(ODI)and Japanese Orthopaedic Association(JOA)score were functionally assessed before the operation and 3 months after the operation.Data were statistically analyzed using SPSS 20.0 and P<0.05 was considered statistically significant.Results The 38 cases were followed up for(9.10±5.34)(3-24)months.There was no significant difference in VAS,ODI and JOA scores between the 2 groups(all P>0.05).There were statistically significant differences in the time of lamina decompression and intraoperative blood loss between the 2 groups(all P<0.05).There were statistically significant differences in VAS,ODI and JOA scores between the preoperative and postoperative value in each group(all P<0.05).Five patients developed postoperative complications including one cerebrospinal fluid leakage,one intervertebral space infection,one pulmonary embolism and 2

关 键 词：模型 结构 人体模型 打印 三维 椎管狭窄 腰椎 减压术 外科 

分 类 号：R68[医药卫生—骨科学]