3D打印技术辅助后路伤椎置钉短节段内固定治疗胸腰段椎体骨折的疗效及安全性  

Efficacy and safety of 3D printing technology-assisted posterior short-segment pedicle screw internal fixation for the treatment of thoracolumbar vertebral fractures

作　　者：任喜颂[1] 杜娟 时艳华 REN Xi-song;DU Juan;SHI Yan-hua(Department of Emergency Trauma Surgery,Nanyang Central Hospital,Nanyang 473000,Henan,CHINA;Department of Surgery,Zhengzhou Shuqing Medical College,Zhengzhou 450000,Henan,CHINA)

机构地区：[1]南阳市中心医院急诊创伤外科,河南南阳473000 [2]郑州澍青医学高等专科学校外科教研室,河南郑州450000

出　　处：《海南医学》2024年第13期1859-1865,共7页Hainan Medical Journal

基　　金：2021年河南省医学科技攻关计划(联合共建)项目(编号:LHGJ20211892)。

摘　　要：目的探讨3D打印技术辅助后路伤椎置钉短节段内固定治疗胸腰段椎体骨折患者的临床疗效和安全性。方法回顾性分析2020年9月至2022年9月南阳市中心医院收治的128例胸腰段椎体骨折患者的临床诊治资料,根据治疗方案不同分为对照组和观察组各64例。对照组患者行后路伤椎置钉短节段内固定,观察组患者行3D打印技术辅助后路伤椎置钉短节段内固定。比较两组患者的手术指标、手术优良率、伤椎前缘高度比、Cobb角、椎体疼痛[视觉模拟量表(VAS)]、椎体功能[日本骨科协会评估量表(JOA)]、围手术期应激激素[皮质醇(COR)、促肾上腺皮质激素(ACTH)、去甲肾上腺素(NE)]和术后并发症。结果观察组患者的手术时间、置钉时间、术中出血量及术中X线透视次数分别为(86.85±12.37)min、(4.29±1.02)min、(91.75±16.29)m L、(13.24±4.07)次,明显少于对照组的(105.34±20.83)min、(14.26±2.15)min、(127.56±29.63)mL、(18.64±5.12)次,差异均有统计学意义(P<0.05);两组患者的手术优良率比较差异无统计学意义(P>0.05);两组患者的伤椎前缘高度比、Cobb角、VAS评分及JOA评分比较差异均无统计学意义(P>0.05);术后1 d及3 d,观察组患者的COR、ACTH及NE分别为(734.27±53.21)nmol/L及(586.34±45.66)nmol/L、(20.41±2.14)pmol/L及(14.26±1.43)pmol/L、(562.37±32.15)ng/L及(410.37±29.41)ng/L,明显低于对照组的(987.26±68.44)nmol/L及(705.69±50.12)nmol/L、(25.63±2.37)pmol/L及(17.85±1.62)pmol/L、(779.82±40.16)ng/L及(568.94±30.25)ng/L,差异均有统计学意义(P<0.05);观察组患者的术后并发症发生率为3.13%,明显低于对照组的14.06%,差异有统计学意义(P<0.05)。结论3D打印技术辅助后路伤椎置钉短节段内固定治疗胸腰段椎体骨折患者效果明显,可增强腰椎功能,减轻疼痛,缓解应激,且术后并发症少。Objective To analyze the effect and safety of 3D printing technology-assisted posterior short-segment pedicle screw internal fixation in the treatment of thoracolumbar vertebral fractures.Methods The clinical diagnosis and treatment data of 128 patients with thoracolumbar vertebral fractures admitted to Nanyang Central Hospital from September 2020 to September 2022 were retrospectively analyzed.The patients were divided into a control group and an observation group according to different treatment plans,with 64 cases in each group.Patients in the control group were treated with posterior short-segment pedicle screw internal fixation,and those in the observation group were treated with posterior short-segment pedicle screw internal fixation under the assistance of 3D printing technology.The surgical indexes,surgical excellence rate,anterior edge height ratio of the injured vertebrae,Cobb angle,vertebral pain[Visual Analogue Scale(VAS)],vertebral function[Japanese Orthopaedic Association Evaluation Scale(JOA)],perioperative stress hormones[cortisol(COR),adrenocorticotropic hormone(ACTH),norepinephrine(NE)],and postoperative complication were compared between the two groups.Results The surgical time,nail placement time of screw,intraoperative blood loss,and frequency of intraoperative X-ray fluoroscopy in the observation group were(86.85±12.37)min,(4.29±1.02)min,(91.75±16.29)mL,and(13.24±4.07)times,respectively,which were significantly lower than(105.34±20.83)min,(14.26±2.15)min,(127.56±29.63)mL,and(18.64±5.12)times of the control group(P<0.05).There was no statistically significant difference in the surgical success rate between the two groups of patients(P>0.05).There was no statistically significant difference in the anterior edge height ratio of the injured vertebra,Cobb angle,VAS score,and JOA score between the two groups(P>0.05).After 1 day and 3 days of surgery,the COR,ACTH,and NE of the observation group were(734.27±53.21)nmol/L and(586.34±45.66)nmol/L,(20.41±2.14)pmol/L and(14.26±1.43)pmol/L,(56

关 键 词：3D打印技术 后路伤椎置钉短节段内固定 胸腰段椎体骨折 功能 应激反应 

分 类 号：R683.2[医药卫生—骨科学]