三维有限元分析技术、3D打印生物模型技术在退行性腰椎侧凸精准手术中的应用价值  

The application value of 3D finite element analysis technology and 3D printing biological model technology in the precise surgery of degenerative lumbar scoliosis

作　　者：孙巍 韦祎[2] 郑雪君 郭杰 于利锋 Sun Wei;Wei Yi;Zheng Xuejun;Guo Jie;Yu Lifeng(Department of Orthopaedics,the Second Hospital of Zhangjiakou,Zhangjiakou 075000,China;Department of Spine Surgery,Bejing Jishuitan Hospital,Bejing 100035,China)

机构地区：[1]张家口市第二医院骨科,张家口075000 [2]北京积水潭医院脊柱外科,北京100035

出　　处：《中国医师杂志》2023年第11期1692-1696,共5页Journal of Chinese Physician

基　　金：河北省医学科学研究重点课题(20181175)。

摘　　要：目的分析三维有限元(FE)分析技术、3D打印生物模型技术在退行性腰椎侧凸(DLS)精准手术中的应用价值。方法选取张家口市第二医院2020年12月至2022年12月住院的96例DLS精准手术患者,按随机数字表法分为两组,对照组(48例)根据术前三维CT重建确定手术方案,观察组(48例)利用三维FE联合3D打印生物模型技术确定手术方案。比较两组围手术期指标(置入椎弓根钉时间、放射线暴露时间、手术时间、术中失血量),手术前后日本骨科协会量表(JOA)、视觉模拟自评量表(VAS)、脊柱侧凸研究学会-22(SRS-22)量表评分及腰椎前凸角、侧凸Cobb角,并发症发生率。结果观察组置入椎弓根钉时间、放射线暴露时间及手术时间均短于对照组(均P<0.05),术中失血量少于对照组(P<0.05)。术后观察组JOA、SRS-22量表评分均高于对照组(均P<0.05),VAS评分低于对照组(P<0.05);观察组腰椎前凸角大于对照组(P<0.05),侧凸Cobb角小于对照组(P<0.05)。观察组并发症发生率[4.17%(2/48)]低于对照组[20.83%(10/48)],差异有统计学意义(P<0.05)。结论DLS术前通过三维FE联合3D打印生物模型模拟手术过程,可有效减少失血量,缩短手术时间,促进受损腰椎功能恢复,减轻术后疼痛感,恢复前凸角,提高生存质量,减少并发症。Objective To analyze the application value of three-dimensional finite element(FE)analysis technology and 3D printing biological model technology in the precise surgery of degenerative lumbar scoliosis(DLS).Methods A total of 96 patients with DLS undergoing precision surgery at the Second Hospital of Zhangjiakou from December 2020 to December 2022 were selected and randomly divided into two groups using a random number table method.The control group(48 cases)was determined based on the surgical plan determined by pre-operative 3D computed tomography(CT)reconstruction,while the observation group(48 cases)was determined using 3D FE combined with 3D printing biological model technology.The perioperative indicators(time of implanting pedicle screws,radiation exposure time,operation time,intraoperative blood loss),pre-and post-operative Japanese Orthopaedic Association scale(JOA),visual analog self-assessment scale(VAS),Scoliosis Research Society-22(SRS-22)scale scores,lumbar lordosis angle,scoliosis Cobb angle,and complication rate were compared between the two groups.Resultsl The time of pedicle screw insertion,radiation exposure time,and operation time in the observation group were shorter than those in the control group(all P<0.05),and the intraoperative blood loss was less than that in the control group(P<0.05).The JOA and SRS-22 scale scores in the observation group were higher than those in the control group(all P<0.05),and the VAS score was lower than that in the control group(P<0.05).The lumbar lordotic angle in the observation group was greater than that in the control group(P<0.05),and the Cobb angle of lateral curvature was smaller than that in the control group(P<0.05).The incidence of complications in the observation group[4.17%(2/48)]was lower than that in the control group[20.83%(10/48)],and the difference was statistically significant(P<0.05).Conclusions Preoperative simulation of the surgical process using 3D FE combined with 3D printing of a biological model can effectively reduce blood loss,shorten

关 键 词：有限元分析 打印 三维 退行性腰椎侧凸 

分 类 号：R687.3[医药卫生—骨科学]