3D打印人工椎体在颈椎脊索瘤全脊椎切除术中的应用  

3D-printed vertebral body in anterior spinal reconstruction after total spondylectomy for patients with cervical chordoma

作　　者：周华[1] 王仁吉 刘忠军[1] 刘晓光[1] 吴奉梁[1] 党礌 韦峰[1] ZHOU Hua;WANG Ren-ji;LIU Zhong-jun;LIU Xiao-guang;WU Feng-liang;DANG Lei;WEI Feng(Department of Orthopaedics,Peking University Third Hospital,Engineering Research Center of Bone and Joint Precision Medicine,Beijing Key Laboratory of Spinal Disease Research,Beijing 100191,China)

机构地区：[1]北京大学第三医院骨科,骨与关节精准医学工程研究中心,脊柱疾病研究北京市重点实验室,北京100191

出　　处：《北京大学学报（医学版）》2023年第1期144-148,共5页Journal of Peking University:Health Sciences

基　　金：北京大学第三医院临床重点项目(BYSY2017001);吴阶平医学基金会临床科研专项基金(320.6750.2022-3-37)。

摘　　要：目的:通过比较颈椎脊索瘤全脊椎切除术后3D打印人工椎体和钛网下沉率的差异,探讨3D打印人工椎体重建前方椎体能否减少术后内植物的下沉。方法:回顾性分析2005年3月至2019年9月在北京大学第三医院行全脊椎切除术的24例颈椎脊索瘤患者资料,其中采用3D打印人工椎体重建颈椎前方椎体(3D椎体组)有9例,采用钛网重建(钛网组)有15例。收集患者的年龄、性别、椎体CT值、手术信息(手术节段、手术时间、出血量及围手术期并发症)和术后内植物下沉等随访资料,采用SPSS 22.0进行数据分析。结果:比较两组患者的性别、年龄、椎体CT值、手术节段、手术时间、出血量及围手术期并发症,差异无统计学意义。术后3个月随访内植物下沉显示,3D椎体组有8例椎体高度下降<1 mm(无内植物下沉),1例椎体高度下降>1 mm(轻度内植物下沉);钛网组有5例椎体高度下降<1 mm(无内植物下沉),8例椎体高度下沉>1 mm(轻度内植物下沉),2例缺失术后3个月的影像学资料,两组3个月内植物下沉率的比较差异有统计学意义(P<0.05)。术后12个月随访内植物下沉显示,3D椎体组有8例椎体高度下降<1 mm(无内植物下沉),1例椎体高度下沉>3 mm(重度内植物下沉);钛网组有4例椎体高度下降<1 mm(无内植物下沉),2例椎体高度下沉>1 mm(轻度内植物下沉),9例椎体高度下沉>3 mm(重度内植物下沉),两组12个月内植物下沉率的比较差异有统计学意义(P<0.01),且两组的重度内植物下沉率(椎体高度下沉>3 mm)比较差异有统计学意义(P<0.05)。术后24个月随访内植物下沉显示,3D椎体组死亡1例,7例椎体高度下降<1 mm(无内植物下沉),1例椎体高度下沉>3 mm(重度内植物下沉);钛网组死亡1例,失访1例,1例椎体高度下降<1 mm(无内植物下沉),1例椎体高度下沉>1 mm(轻度内植物下沉),11例椎体高度下沉>3 mm(重度内植物下沉),两组24个月内植物下沉率比较差�Objective:To investigate whether 3D-printed artificial vertebral body can reduce prosthesis subsidence rate for patients with cervical chordomas,through comparing the rates of prosthesis subsidence between 3D printing artificial vertebral body and titanium mesh for anterior spinal reconstruction after total spondylectomy.Methods:This was a retrospective analysis of patients who underwent surgical treatment for cervical chordoma at our hospital from March 2005 to September 2019.There were nine patients in the group of 3D artificial vertebral body(3D group),and 15 patients in the group of titanium mesh cage(Mesh group).The patients’characteristics and treatment data were extracted from the medical records,including age,gender,CT hounsfield unit of cervical vertebra and surgical information,such as the surgical segments,time and blood loss of surgery,frequency and degree of prosthesis subsidence after surgery.Radiographic observations of prosthesis subsidence during the follow-up,including X-rays,CT,and magnetic resonance imaging were also collected.SPSS 22.0 was used to analysis the data.Results:There was no significant difference between the two groups in gender,age,CT hounsfield unit,surgical segments,time of surgery,blood loss of posterior surgery and total blood loss.Blood loss of anterior surgery was 700(300,825)mL in 3D group and 1500(750,2800)mL in Mesh group(P<0.05).The prosthesis subsidence during the follow-up,3 months after surgery,there was significant difference between the two groups in mild prosthesis subsidence(P<0.05).The vertebral height of the 3D group decreased less than 1 mm in eight cases(no prosthesis subsidence)and more than 1 mm in one case(mild prosthesis subsidence).The vertebral height of the Mesh group decreased less than 1 mm in five cases(no prosthesis subsidence),and more than 1 mm in eight cases(mild prosthesis subsidence).Two patients did not have X-rays in 3 months after surgery.There was a statistically significant difference between the two groups in the prosthesis subsidence

关 键 词：颈椎脊索瘤 全脊椎切除术 3D打印人工椎体 钛网 内植物下沉 

分 类 号：R739.9[医药卫生—肿瘤]