3D打印联合"O"型臂导航辅助半椎体切除治疗先天性颈胸段侧凸畸形  

3D printing combined with O-arm navigation-assisted posterior posterior hemivertebra resection and correctional surgery in treatment of congenital cervicothoracic scoliosis

作　　者：张锴 王红强 邢帅 张广泉 胡巍然 朱宇 高延征 Zhang Kai;Wang Hongqiang;Xing Shuai;Zhang Guangquan;Hu Weiran;Zhu Yu;Gao Yanzheng(Department of Spine and Spinal Cord Surgery,Henan Provincial People's Hospital(People's Hospital of Zhengzhou University),Zhengzhou 450003,China)

机构地区：[1]河南省人民医院(郑州大学人民医院)脊柱脊髓外科,郑州450003

出　　处：《中华骨科杂志》2024年第8期544-552,共9页Chinese Journal of Orthopaedics

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20220036);河南省科技攻关项目(242102310077)。

摘　　要：目的探讨3D打印联合"O"型臂(O-arm)导航辅助后路半椎体切除治疗先天性颈胸段侧凸畸形的临床疗效。方法回顾性分析2015年1月至2021年6月河南省人民医院收治的半椎体畸形致先天性颈胸段侧凸患儿14例,男9例、女5例,年龄(8.9±3.2)岁(范围1~15岁)。记录手术时间、术中出血量及融合节段。术中行O-arm扫描、术后行CT扫描评估置钉准确率。分析术前、模型设计、术后1周及末次随访时影像学测量颈胸段侧凸Cobb角、代偿性侧凸Cobb角、局部后凸Cobb角、颈椎倾斜角、T1倾斜角及锁骨角,评估手术设计、术中矫形及随访丢失情况。采用脊柱侧凸研究学会-22简明量表调查问卷(Scoliosis Research Society question naires-22,SRS-22)评估功能及临床疗效。末次随访时采用Eck融合分级标准评价植骨融合情况。结果14例患儿均顺利完成手术,手术时间(228.5±41.8)min,术中出血量(355.6±46.7)ml,融合节段为(5.5±0.8)个,随访(35.5±13.2)个月。共置入140枚椎弓根螺钉,置钉准确率97.1%(136/140)。颈胸段侧凸Cobb角术前为53.9°±17.9°、模型设计为11.3°±4.4°、术后1周为10.8°±2.6°、末次随访为14.5°±3.5°,差异有统计学意义(P<0.001),术后1周与术前的差异有统计学意义(P<0.001),术后矫形率为78.6%±6.7%。代偿性侧凸Cobb角术前为33.1°±12.1°、模型设计为11.9°±2.4°、术后1周为10.5°±3.4°、末次随访为14.1°±2.5°,差异有统计学意义(P<0.001),术后1周与术前的差异有统计学意义(P<0.001),术后矫形率为65.2%±16.2%。局部后凸Cobb角术前为27.8°±9.8°、模型设计为10.1°±2.1°、术后1周为9.8°±1.9°、末次随访为12.7°±1.6°,差异有统计学意义(P<0.001),术后1周与术前的差异有统计学意义(P<0.001),术后矫形率为59.2%±18.9%。颈椎倾斜角术前为20.6°±6.7°、模型设计为6.2°±1.9°、术后1周为5.9°±2.1°、末次随访为7.1°±1.4°,差异有统计学意义(P<0.001),术后1周Objective To investigate the clinical effect of 3D printing combined with O-arm navigation assisted posterior hemivertebrae resection and orthopedic fixation in the treatment of congenital cervicothoracic scoliosis.Methods A retrospective study was conducted on the clinical data of 14 patients with congenital cervicothoracic kyphosis caused by hemivertebra treated in Henan Provincial People's Hospital from January 2015 to June 2021,including 9 males and 5 females,aged 8.9±3.2 years(range,1-15 years).Operation time,intraoperative blood loss and fusion stage were recorded.Intraoperative O-arm scanning and postoperative CT scanning were performed to evaluate the accuracy of nail placement.The cervicothoracic scoliosis Cobb angle,compensatory scoliosis Cobb angle,local kyphosis Cobb angle,torticollis angle,T1 tilt angle and clavicular angle were measured before operation,model design,1 week after operation and at the last follow-up to evaluate the effect of surgical design,intraoperative orthosis and the correction loss at follow-up.The Society for Scoliosis Research-22(SRS-22)questionnaire was used to evaluate the functional and treatment effect.At the last follow-up,the osteotomy fusion was evaluated by Eck criterion.Results All patients successfully completed the operation,the operation time was 228.5±41.8 min,the intraoperative blood loss was 355.6±46.7 ml,and the number of fusion segments was 5.5±0.8.Follow-up duration was 35.5±13.2 months.A total of 140 pedicle screws were inserted,with an accuracy of 97.1%(136/140).The Cobb angle of cervicothoracic scoliosis was 53.9°±17.9°preoperatively,11.3°±4.4°in the model design,10.8°±2.6°one week postoperatively,and 14.5°±3.5°at the last follow-up,with statistical significance(P<0.001).The preoperative and postoperative one week difference was statistically significant(P<0.001)with a correction rate of 78.6%±6.7%.The Cobb angle of compensatory scoliosis was 33.1°±12.1°before surgery,11.9°±2.4°for model design,10.5°±3.4°for one week after surger

关 键 词：颈椎 胸椎 脊柱侧凸 先天畸形 脊柱融合术 手术导航系统 

分 类 号：R687.3[医药卫生—骨科学]