3D打印与导航辅助椎弓钉矫正先天性脊柱畸形  

3D printed guider versus computer navigation for pedicle screw placement in correction of congenital spinal deformities

作　　者：徐会法 李超 刘峙辰 第五维龙 沙佳 官哲轩 严亚波 赵晓蕾 漆伟 黄鲁豫 XU Hui-fa;LI Chao;LIU Zhi-chen;DIWU Wei-long;SHA Jia;GUAN Zhe-xuan;YAN Ya-bo;ZHAO Xiao-lei;QI Wei;HUANG Lu-yu(Department of Orthopedics,The First Affiliated Hospital,Air Force Military Medical University,Xi'an 710032,China)

机构地区：[1]空军军医大学第一附属医院骨科,陕西西安710032

出　　处：《中国矫形外科杂志》2021年第21期1921-1926,共6页Orthopedic Journal of China

基　　金：陕西省科技厅自然科学基础研究项目(编号:2017JC2-04)。

摘　　要：[目的]比较3D打印导板与计算机导航辅助置钉矫正先天性脊柱畸形的临床效果。[方法]回顾性分析2015年1月—2018年12月本院收治的55例先天性脊柱畸形患者的临床资料,根据术前医师与患儿家长沟通结果将患儿分为两组。其中,36例采用3D打印导板辅助置钉(3D组),19例采用导航下置钉(导航组)。对比两组患者围手术期、随访及影像学资料。[结果]两组患者均顺利完成手术,3D打印组手术时间、置钉时间、术中出血量显著少于导航组,差异具有统计学意义(P<0.05)。透视次数多于导航组,(P<0.05)。而两组间切口长度、精准置钉率、术后引流量以及住院时间差异无统计学意义(P>0.05)。平均随访(45.72±13.69)个月,随术后时间推移,两组患者VAS、ODI、JOA和SRS-22评分均显著改善(P<0.05)。3D打印组SRS-22评分术后及末次随访均优于导航组(P<0.05)。影像学评估方面,置钉准确率3D打印组为(93.64±3.36)%,导航组为(95.08±2.97)%,差异无统计学意义(P>0.05)。与术前相比,术后两组患者冠状面Cobb角、局部后凸Cobb角、C7-S1冠状面偏移(C7PL-CSVL)、矢状面偏移(SVA)均显著改善(P<0.05)。相应时间点,两组间上述影像指标的异均无统计学意义(P>0.05)。[结论]两种技术均可达到精准置钉、良好矫形的目的,相比之下,3D打印导板技术在手术时间、置钉时间、术中出血量及满意度方面更具优势。[Objective]To compare the clinical outcomes of 3D printed guider versus computer navigation for pedicle screw placement in correction of congenital spinal deformities.[Methods]A retrospective study was conducted on 55 patients who underwent surgical correc⁃tion for congenital spinal deformities in our hospital from January 2015 to December 2018.The patients were divided into two groups based on the consequences of preoperative doctor-patient communication.Among them,36 patients had pedicle screw placed with the 3D printed guider plates,while the remaining 19 patients had the screw inserted by assistance of computer navigation.The perioperative period,followup and imaging data were compared between the two groups.[Results]The patients in both groups had operation completed successfully.The 3D printed group proved significantly superior to the navigation group in terms of operation time,screw placement time,and intraopera⁃tive blood loss(P<0.05),despite of the fact that the former had more frequent fluoroscopy intraoperatively than the latter(P<0.05).Howev⁃er,there were no significant differences in incision length,accuracy of screw placement,postoperative drainage volume,and hospital stay between the two groups(P>0.05).As time went during follow up lasted for(45.72±13.69)months,the VAS,ODI,JOA and SRS-22 scores significantly improved in both groups(P<0.05).The 3D printing group was better than the navigation group in SRS-22 scores after surgery and the last follow-up(P<0.05).Regrading to imaging evaluation,the accuracy of screw placement was(93.64±3.36)%in the 3D printed group,whereas(95.08±2.97)%in the navigation group,which was not statistically significant(P>0.05).Compared with those preoperative⁃ly,the scoliotic Cobb angle,local kyphotic Cobb angle,deviations in C7PL-CSVL,and SVA were significantly improved in the two groups after surgery(P<0.05).At any corresponding time point,there were no statistically significant difference in the above-mentioned radio⁃graphic items between the two groups(P>0.

关 键 词：先天性脊柱畸形 3D 打印 导板 计算机导航 椎弓钉固定 

分 类 号：R687[医药卫生—骨科学]