3D打印导向模板在骨质疏松腰椎后路融合术中的应用  

Application of 3D Printed Guide Template in Posterior Lumbar Fusion with Osteoporosis

作　　者：陈惠国[1] 邵荣学[1] 阮立奇 乐军[1] 胡劲涛 周辉[1] Chen Huiguo;Shao Rongxue;Ruan Liqi;Le Jun;Hu Jingtao;Zhou Hui(Department of Orthopaedics,Hangzhou Hospital of Traditional Chinese Medicine,Hangzhou 310007,China)

机构地区：[1]杭州市中医院骨科,浙江杭州310007

出　　处：《实用骨科杂志》2023年第12期1057-1061,共5页Journal of Practical Orthopaedics

基　　金：浙江省医药卫生科研面上项目(2018KY616)。

摘　　要：目的 探讨3D打印皮质骨轨迹螺钉(cortical bone trajectory, CBT)导向模板在腰椎CBT内固定术中的有效性、安全性与术中注意事项。方法 2019年1月至2020年12月杭州市中医院收治合并骨质疏松的腰椎退变性疾病患者74例,男43例,女31例;年龄68~74岁,平均(69.82±5.73)岁。其中导向模板组(导板组)39例,男17例,女22例;年龄68~73岁,平均(70.24±3.83)岁。徒手螺钉组(徒手组)35例,男14例,女21例;年龄68~74岁,平均(69.51±3.52)岁。收集两组患者疾病诊断、性别和年龄以及出血量(术中出血量+术后引流量)、手术时长、术中X线透视次数及螺钉位置影像学评估。使用Oswestry功能障碍指数(Oswestry disability index, ODI)和疼痛视觉模拟评分(visual analogue scale, VAS)等评价功能恢复情况。分析并比较两组术后伤口感染、置入螺钉失败或破壁等并发症。结果 所有患者均获得随访,随访时间12~30个月,平均(20.92±8.57)个月。导板组手术时长(98±17)min,徒手组(223±16)min,差异有统计学意义(t=-23.20,P=0.03);导板组出血量(80.00±12.65)mL,显著低于徒手组(230.00±38.70)mL(t=-36.62,P=0.03);导板组术中放射次数(3次)比徒手组(12次)明显减少(t=-5.65,P<0.01)。术后导板组与徒手组伤口感染、内固定失败等发生率差异均无统计学意义(t=0.94、P=1.00)。末次随访两组VAS评分和ODI评分差异无统计学意义(t=-1.05、-0.79,P=0.28、P=0.36)。结论 导向模板CBT置入技术具有缩短手术时长、减少出血量、降低患者与医护人员辐射伤害等优点,是更经济、快捷、有效的CBT置入技术。Objective To explore the effectiveness,safety,and intraoperative precautions of 3D printed cortical bone trajectory(CBT)guiding template in lumbar CBT fixation surgery Methods The clinical data of 74 patients with osteoporotic lumbar degenerative diseases treated in Hangzhou Hospital of Traditional Chinese Medicine from January 2019 to December 2020 were collected.There were 43 males and 31 females.The age ranged from 68 to 74 years,with an average age of(69.82±5.73)years.There were 39 patients in the guided template CBT group,including 17 males and 22 females.The average age was(70.24±3.83)years(range 68 to 73 years).There were 35 patients in the manual CBT group,including 14 males and 21 females,aged 68 to 74 years,with an average age of(69.51±3.52)years.Gender,age,disease diagnosis,operation duration,blood loss(intraoperative and postoperative blood loss),intraoperative fluoroscopy times and screw location imaging evaluation were collected.The Oswestry disability index(ODI)and visual analogue scale(VAS)were used to evaluate the functional recovery of the patients preoperative,postoperative,and at follow-up at the end of one year.Postoperative complications such as wound infection,fusion device displacement,screw extraction and fixation rupture were compared between guided template CBT implantation and manual screw implantation.Results All patients were followed up for 12 to 30 months,with a mean of(20.92±8.57)months.There was a statistically significant difference in operation time between the guided template group and the freehand screw group(t=-23.20,P=0.03).The blood loss in guided template CBT group(80.00±12.65)mL was significantly lower than that(230.00±38.70)mL in manual CBT group(t=-36.62,P=0.03).The number of radiation-oriented CBT sessions during surgery was significantly lower than that in the hands-free group(3 VS 12 sessions,t=-5.65,P<0.01).There were no significant differences in the incidence of wound infection and internal fixation failure between the guided template group and the free han

关 键 词：3D打印导向模板 徒手 皮质骨轨迹螺钉 骨质疏松 腰椎后路融合术 

分 类 号：R681.57[医药卫生—骨科学]