3D打印辅助置钉联合改良PLIF在退行性脊柱侧弯矫形中的应用  

3D Printing Assisted Screw Placement Combined withImproved PLIF in the Correction of Degenerative Scoliosis

作　　者：李亮 梁梅 王聪聪 沈世彬 黄浩然 周政纲 Li Liang;Liang Mei;Wang Congcong;Shen Shibin;Huang Haoran;Zhou Zhenggang(Department of Spinal Surgery,Chengyang District People’s Hospital,Qingdao 266100,China)

机构地区：[1]青岛市城阳区人民医院脊柱外科,山东青岛266100

出　　处：《实用骨科杂志》2023年第12期1062-1069,共8页Journal of Practical Orthopaedics

摘　　要：目的 探讨3D打印辅助椎弓根钉置入联合改良后路腰椎椎间融合术(posterior lumbar interbody fusion, PLIF)治疗退行性脊柱侧弯的临床效果。方法 选取2020年3月至2022年3月青岛市城阳区人民医院脊柱外科收治的退行性脊柱侧弯患者47例,随机分为观察组与对照组。对照组23例患者,男11例,女12例;年龄54~76岁,平均(63.09±6.22)岁;均选择常规后路椎弓根螺钉固定矫形术及PLIF的手术方式。观察组24例患者,男11例,女13例;年龄51~72岁,平均(60.64±5.65)岁;在术前应用3D打印技术制定手术方案后进行后路椎弓根螺钉固定矫形术及保留后纵韧带复合体的改良PLIF手术治疗。比较两组患者的手术时间、透视次数、置钉时间、术中出血量和术后引流量,术前及术后1个月、6个月、12个月日本骨科协会(Japanese orthopaedic association, JOA)脊髓功能评分、疼痛视觉模拟评分(visual analogue scale, VAS)、Oswestry功能障碍指数(Oswestry disability index, ODI)变化,术前及末次随访Cobb角变化,置钉情况及并发症发生情况。结果 两组患者均顺利完成手术。观察组术中实际置入的椎弓根螺钉的直径和长度、进钉点与后正中线的距离以及椎弓根钉外展角度等指标与术前椎弓根钉置入的测量情况基本相同,差异无统计学意义(P>0.05);观察组在术中置钉可接受率及准确率上明显高于对照组(P<0.05);观察组在手术时间、透视次数、置钉时间、术中出血量和术后引流量方面的比较均低于对照组(P<0.05)。所有手术患者均获得随访,随访时间为12~18个月,平均(13.20±2.51)个月。观察组在术后1个月、6个月及12个月的VAS、JOA评分及ODI明显优于对照组(P<0.05);并发症方面,观察组也优于对照组(P<0.05)。结论 应用3D打印辅助置钉联合改良PLIF治疗退行性脊柱侧弯,能显著减少手术时间、透视次数、置钉时间、术中出血量及术后引流量,提高手术效率及手术Objective To investigate the clinical effect of 3D printing assisted pedicle screw placement combined with improved posterior lumbar interbody fusion(PLIF)in the treatment of degenerative scoliosis.Methods From March 2020 to March 2022,47 patients with degenerative scoliosis admitted to the Spinal Surgery Department of Chengyang District People’s Hospital in Qingdao were randomLy divided into an observation group and a control group.The control group consisted of 23 patients,including 11 males and 12 females with an age range of 54~76 years and an average age of(63.09±6.22)years.The patients of control group underwent conventional posterior pedicle screw fixation and PLIF surgery.The observation group consisted of 24 patients,including 11 males and 13 females with an age range of 51~72 years and an average age of(60.64±5.65)years.The patients underwent posterior pedicle screw fixation and modified PLIF surgery with the preoperative use of 3D printing technology to develop a surgical plan while preserving the posterior longitudinal ligament complex.The surgical time,fluoroscopy times,screw placement time,intraoperative blood loss,postoperative drainage volume,Japanese orthopaedic association(JOA)spinal cord function score,visual analogue scale(VAS)pain score,Oswestry disability index(ODI)score changes at preoperative,1 month,6 months,and 12 months,Cobb angle changes at preoperative and final follow-up,screw placement status,and occurrence of complications were compared between the two groups.Results Both groups successfully completed the surgery.The measurements of the actual diameter and length of the pedicle screws,the distance from the entry point to the posterior midline,and the pedicle screw angulation in the observation group were similar to the preoperative measurements of the pedicle screws,with no statistically significant differences(P>0.05).The observation group had significantly higher acceptable and accurate screw placement rates during surgery compared to the control group(P<0.05).The observation

关 键 词：退行性脊柱侧弯 3D打印技术 后方棘突韧带复合体 后路腰椎椎间融合术 

分 类 号：R682.13[医药卫生—骨科学]