3D打印技术术前预设计在老年性腰椎管狭窄症手术中的运用  

Application of 3D printing in preoperative predesign for senile lumbar spinal stenosis surgery

作　　者：张怀志[1] 林海滨[1] 戴建辉[1] 陈旭[1] 李星[1] 余正希 唐晓璐 ZHANG Huaizhi;LIN Haibin;DAI Jianhui;CHEN Xu;LI Xing;YU Zhengxi;TANG Xiaolu(Minimally Invasive Spine Surgery,the Affiliated Hospital of Putian University,Fujian Province,Putian351100,China;Department of Medical Imaging,the Affiliated Hospital of Putian University,Fujian Province,Putian351100,China)

机构地区：[1]莆田学院附属医院微创脊柱外科,福建莆田351100 [2]莆田学院附属医院医学影像科,福建莆田351100

出　　处：《中国当代医药》2022年第36期74-78,共5页China Modern Medicine

基　　金：福建省中青年教师教育科研项目(JAT200533)。

摘　　要：目的 观察术前3D打印预设计在显微镜辅助老年性腰椎管狭窄症微创非融合手术中的运用效果。方法 选取2020年6月至2021年12月莆田学院附属医院微创脊柱外科的82例老年性腰椎管狭窄症患者作为研究对象,采用区组随机方法将纳入研究的患者分为A组和B组,每组各41例。两组均在显微镜辅助微创固定通道下行腰椎椎管减压手术,A组采用术前3D打印腰椎模型评估进行预手术,确定手术入路的穿刺点和工作通道的方向及其倾斜角度,精准定位预设计,在术中参考术前3D打印模型。B组根据术前阅片,结合手术经验常规行椎间孔镜手术。比较两组患者的手术时间、术中出血量及住院时间,采用视觉模拟评分法(VAS)评分比较术后1、2周患者疼痛程度,术后3、6个月后比较患者Oswestry功能障碍指数(ODI)及其改善指数。结果 两组的手术时间、住院时间比较,差异无统计学意义(P>0.05)。A组的术中出血量少于B组,差异有统计学意义(P<0.001)。两组术后1、2周的VAS评分均低于本组术前,差异有统计学意义(P<0.05),A组术后3、6个月的单项能力评分、个人综合能力评分、ODI评分均低于B组,差异有统计学意义(P<0.001)。两组术后3、6个月的疼痛评分、单项能力评分、个人综合能力评分、ODI评分低于本组术前,差异有统计学意义(P<0.001)。A组术后3、6个月的ODI改善指数低于B组,差异有统计学意义(P<0.001)。两组术后6个月的ODI改善指数低于本组术后3个月,差异有统计学意义(P<0.001)。两组的不良反应发生率比较,差异无统计学意义(P>0.05)。结论 3D打印技术的术前精准定位预设计在显微镜辅助老年性腰椎管狭窄症微创非融合手术中的运用可以有效减少术中出血量,改善功能障碍。Objective To observe the effect of preoperative 3D printing predesign in microscopy-assisted non-fusion surgery for senile lumbar spinal stenosis. Methods A total of 82 patients with senile lumbar spinal stenosis from the Minimally Invasive Spine Surgery of the Affiliated Hospital of Putian University from June 2020 to December 2021 were selected as the research objects. The patients were divided into group A and group B by block randomized method, with 41cases in each group. Both groups underwent lumbar spinal canal decompression under microscope-assisted minimally invasive fixed channels. Group A underwent pre-operation by 3D printing of the lumbar model before surgery to determine the puncture point of the surgical approach and the direction and tilt angle of the working channel, precise positioning and pre-design, and referred to the preoperative 3D printing model during the operation. In group B, foraminal endoscopic surgery was performed according to preoperative radiograph reading and surgical experience. The operation time,intraoperative blood loss and hospital stay of the two groups were compared. Visual analog scale(VAS) was used to compare the pain degree 1 and 2 weeks after surgery, and the Oswestry disability index(ODI) score and its improvement index,adverse reactions were compared 3 and 6 months after surgery. Results There were no significant differences in operation time and hospital stay between the two groups(P>0.05).The intraoperative blood loss in group A was less than that in group B, the difference was statistically significant(P<0.001). VAS scores 1 and 2 weeks after surgery were lower than those before surgery, the differences were statistically significant(P <0.05). Individual ability scores, individual comprehensive ability scores and ODI scores of group A were lower than those of group B 3 and 6 months after surgery, the differences were statistically significant(P<0.001). Pain score, individual ability score, individual comprehensive ability score and ODI score 3 and 6 months after su

关 键 词：显微镜 3D打印 精准定位 老年性腰椎管狭窄症 

分 类 号：R687.3[医药卫生—骨科学]