3D打印预置钉道模型辅助置钉治疗单发性完全分节型先天性半椎体的临床疗效  

Clinical efficacy of screw placement assisted with the 3D printing pre-installed screw channel model in the single complete segmented congenital hemivertebrectomy

作　　者：施新革 宋月鹏 胡巍然 马浩浩 邢帅 高延征 Shi Xin′ge;Song Yuepeng;Hu Weiran;Ma Haohao;Xing Shuai;Gao Yanzheng(Department of Spine and Spinal Surgery,Henan Province People′s Hospital,Henan University People′s Hospital,Zhengzhou University People′s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院,河南大学人民医院,郑州大学人民医院脊柱脊髓外科,郑州450003

出　　处：《中华实用儿科临床杂志》2022年第3期200-204,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：河南省医学科技攻关计划(LHGJ20200047);河南省医学教育研究项目(Wjlx2020388)。

摘　　要：目的探讨3D打印预置钉道模型在单发性完全分节型先天性半椎体切除术中的临床疗效。方法回顾性分析2016年8月至2019年1月河南省人民医院脊柱脊髓外科收治的13例单发性完全分节型先天性半椎体患儿的临床资料,其中男5例,女8例;年龄5-14岁,平均9.9岁。病变位置在T_(9)3例、T_(10)2例、T_(11)5例、T_(12)1例、L_(1)2例。术中使用3D打印预置钉道模型辅助置入椎弓根螺钉,通过术后CT评估置钉的准确性。所有患儿术前、术后常规拍摄站立位脊柱全长正侧位X线片,测量冠状面及矢状面Cobb角,术后及随访时计算脊柱侧、后凸矫正率。术前、术后及随访时脊柱侧、后凸Cobb角的比较采用单因素重复测量方差分析。结果13例患儿共置入椎弓根螺钉85枚,置钉准确率为95.3%。手术时间(216.9±28.3)min;出血量(478.5±132.6)mL。术前侧凸Cobb角为(57.1±12.7)°,术后为(12.7±4.7)°,矫正率为(78.4±5.9)%,末次随访时为(14.2±7.0)°;术前后凸Cobb角为(46.2±8.4)°,术后为(13.2±4.4)°,矫正率为(72.6±7.0)%,末次随访为(14.0±3.4)°。患儿均未出现严重血管及神经损伤等并发症。术后随访12.3个月(6-18个月),随访期间未见明显角度丢失。术后与末次随访时,侧、后凸角度与术前比较,差异均有统计学意义(均P<0.05);术后侧、后凸角度与末次随访时比较,差异均无统计学意义(均P>0.05)。结论在单发性完全分节型先天性半椎体切除术过程中,3D打印预置钉道模型可提高螺钉置入的精准性,改善脊柱侧后凸畸形的矫形效果。Objective To explore the clinical effect of the 3D printing pre-installed screw channel model in assisting screw placement of single complete segmented congenital hemivertebrectomy.Methods Clinical data of 13 children treated with single complete segmented congenital hemivertebrectomy in the Department of Spine and Spinal Surgery of Henan Provincial People′s Hospital from August 2016 to January 2019 were retrospectively analyzed.Among them,there were 5 males and 8 females with the mean age of 9.9(5-14)years.Categorized by the lesion location,3 cases were located at T_(9),2 cases at T_(10),5 cases at T_(11),1 case at T_(12),and 2 cases at L_(1).During the operation,the 3D printing pre-installed screw channel model was used to assist the placement of pedicle screws.The accuracy of screw placement was assessed by the postoperative CT.All children were routinely examined by full-length anterior and lateral X-ray of spine in the standing position before and after surgery to measure the Cobb angles at the coronal and sagittal view.Furthermore,the correction rate of scoliosis and kyphosis after surgery and during follow-up was also calculated.The One-Way repeated measures ANOVA was used to compare the Cobb angle of scoliosis and kyphosis before surgery,after surgery and during follow-up.Results A total of 85 pedicle screws were placed in 13 children,with the accuracy rate of screw placement of 95.3%.The mean surgery time and intraoperative blood loss were(216.9±28.3)min,and(478.5±132.6)mL,respectively.Scoliosis Cobb was corrected from(57.1±12.7)°to(12.7±4.7)°with a correction rate of(78.4±5.9)%,which was(14.2±7.0)°at the last follow-up.Kyphosis angle was corrected from(46.2±8.4)°to(13.2±4.4)°with a correction rate of(72.6±7.0)%,which was(14.0±3.4)°at the last follow-up.None of the children had serious complications like vascular and nerve damage.The mean postoperative follow-up was 12.3(6-18)months.No significant loss of angle was detected during the follow-up period.There were significant differences

关 键 词：脊柱侧凸 脊柱后凸 3D打印 半椎体切除 

分 类 号：R726.8[医药卫生—儿科]