3D打印人工椎体及椎间融合器在颈椎前路手术中应用的临床效果  被引量:13

Effectiveness of three-dimensional printing artificial vertebral body and interbody fusion Cage in anterior cervical surgery

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作  者:王志强[1] 冯皓宇[1] 马迅[1] 陈晨[1] 邓晨 孙麟[1] WANG Zhiqiang;FENG Haoyu;MA Xun;CHEN Chen;DENG Chen;SUN Lin(Department of Orthopedics,Third Hospital of Shanxi Medical University(Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences,Tongji Shanxi Hospital),Taiyuan Shanxi,030032,P.R.China)

机构地区:[1]山西医科大学第三医院(山西白求恩医院山西医学科学院同济山西医院)骨科,太原030032

出  处:《中国修复重建外科杂志》2021年第9期1147-1154,共8页Chinese Journal of Reparative and Reconstructive Surgery

摘  要:目的评估应用3D打印人工椎体和3D打印椎间融合器(Cage)行颈前路椎间盘切除植骨融合术(anterior cervical disectomy and fusion,ACDF)联合颈前路椎体次全切除减压植骨融合术(anterior cervical corpectomy and fusion,ACCF)的临床效果。方法回顾分析2018年5月—2019年12月收治并行ACCF联合ACDF治疗的29例多节段脊髓型颈椎病患者临床资料,其中13例采用3D打印人工椎体与3D打印Cage(3D打印组),16例采用钛网笼(titanium mesh cage,TMC)与Cage(TMC组)。两组患者性别、年龄、手术节段、Nurick分级、病程及术前日本骨科协会(JOA)评分、疼痛视觉模拟评分(VAS)、融合节段Cobb角等一般资料比较差异均无统计学意义(P>0.05)。记录并比较两组患者手术时间、术中出血量、住院时间、并发症及末次随访时植入物融合情况;术前、术后即刻、术后6个月及末次随访时,采用JOA评分评价神经功能改善情况并计算末次随访时改善率,采用VAS评分评价上肢和颈部疼痛改善情况,测量融合节段Cobb角并计算末次随访时与术后即刻的差值;术后即刻、术后6个月及末次随访时,测量融合节段椎体前缘高度(height of the anterior bord,HAB)和椎体后缘高度(height of the posterior bord,HPB),并计算植入物沉降发生率。结果3D打印组手术时间显著少于TMC组(t=3.336,P=0.002);两组住院时间和术中出血量比较差异均无统计学意义(P>0.05)。两组患者均获随访,随访时间12~19个月,平均16个月。两组术后均未发生明显并发症。重复测量方差分析示,JOA评分、VAS评分与Cobb角各时间点间差异均有统计学意义(P<0.05)。JOA评分中时间与组别有交互作用(F=3.705,P=0.025),随时间延长,3D打印组与TMC组JOA评分升高幅度不同,3D打印组升高幅度更大。VAS评分中时间与组别无交互作用(F=3.038,P=0.065),且两组间各时间点评分差异无统计学意义(F=0.173,P=0.681)。Cobb角的时间与组别有交互作用(F=15.5Objective To evaluate the effectiveness of three-dimensional(3D)printing artificial vertebral body and interbody fusion Cage in anterior cervical disectomy and fusion(ACCF)combined with anterior cervical corpectomy and fusion(ACDF).Methods The clinical data of 29 patients with multilevel cervical spondylotic myelopathy who underwent ACCF combined with ACDF between May 2018 and December 2019 were retrospectively analyzed.Among them,13 patients were treated with 3D printing artificial vertebral body and 3D printing Cage as 3D printing group and 16 patients with ordinary titanium mesh Cage(TMC)and Cage as TMC group.There was no significant difference in gender,age,surgical segment,Nurick grade,disease duration,and preoperative Japanese Orthopaedic Association(JOA)score,visual analogue scale(VAS)score,and Cobb angle of fusion segment between the two groups(P>0.05).The operation time,intraoperative blood loss,hospitalization stay,complications,and implant fusion at last follow-up were recorded and compared between the two groups;JOA score was used to evaluate neurological function before operation,immediately after operation,at 6 months after operation,and at last follow-up;VAS score was used to evaluate upper limb and neck pain.Cobb angle of fusion segment was measured and the difference between the last follow-up and the immediate after operation was calculated.The height of the anterior border(HAB)and the height of the posterior border(HPB)were measured immediately after operation,at 6 months after operation,and at last follow-up,and the subsidence of implant was calculated.Results The operation time of 3D printing group was significantly less than that of TMC group(t=3.336,P=0.002);there was no significant difference in hospitalization stay and intraoperative blood loss between the two groups(P>0.05).All patients were followed up 12-19 months(mean,16 months).There was no obvious complication in both groups.There were significant differences in JOA score,VAS score,and Cobb angle at each time point between the two g

关 键 词:3D打印 颈前路椎间盘切除植骨融合术 颈前路椎体次全切除减压植骨融合术 多节段脊髓型颈椎病 植骨融合 钛网笼 

分 类 号:R687.3[医药卫生—骨科学]

 

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