个体化3D打印人工椎体置换在复杂脊柱结核重建中的应用  

Application of individualized 3D printed artificial vertebral body replacement in reconstruction of complex tuberculosis-affected spine

作　　者：刘思源 寸新华 吴磊 白平 周奕 饶涛 陈林 窦吉辰 赵衡 王一州 Liu Siyuan;Cun Xinhua;Wu Lei;Bai Ping;Zhou Yi;Rao Tao;Chen Lin;Dou Jichen;Zhao Heng;Wang Yizhou(Department of Orthopedics,the Third People’s Hospital of Kunming City,Kunming 650041,China)

机构地区：[1]昆明市第三人民医院骨科,昆明650041

出　　处：《中国防痨杂志》2024年第8期918-925,共8页Chinese Journal of Antituberculosis

基　　金：昆明市卫生健康委员会卫生科研课题(2023-04-07-004)。

摘　　要：目的:探讨个体化3D打印人工椎体在脊柱结核重建中的临床效果。方法:回顾性研究2021年5月至2023年5月昆明市第三人民医院骨科收治的208例脊柱结核患者,其中15例成人患者采用了病灶清除联合个体化3D打印人工椎体重建脊柱手术进行治疗。其中,男性5例,女性10例;年龄31~72岁,平均(45.1±13.2)岁。病变部位包括胸椎2例,胸腰段2例,腰椎1例,腰骶椎10例;病变节段累及2个椎体6例,累及≥3个椎体9例。随访观察术后人工椎体稳定情况、与相邻椎体骨长入情况,以及手术前后神经功能改变情况、疼痛视觉模拟评分(visual analogue scale,VAS)变化情况、畸形矫正情况和结核病复发情况。结果:15例患者均顺利完成手术,未出现严重血管、神经并发症。其中,单纯前路手术8例,一期后路手术2例,后前路手术5例。手术时间(292.2±119.0)min,术中失血量(553.3±333.5)ml。术前VAS评分为(5.7±0.9)分,术后7 d评分为(2.9±0.5)分,末次随访时评分为(1.8±0.5)分,术后7 d及末次随访较术前的差异均有统计学意义(t=9.599,P<0.001;t=13.752,P<0.001)。术后1个月,1例术前Frankel分级为A级的患者逐渐恢复至D级,3例术前Frankel分级为B级的患者,2例恢复至D级,1例恢复至C级。2例术中施行脊柱后凸矫正的患者,在随访期内人工椎体无松动移位,内固定未断裂失效。15例患者随访期间均未发现结核病复发。结论:3D打印人工椎体在脊柱结核重建中应用的短期疗效较好,人工椎体融合情况还需进一步观察研究。Objective:To investigate the clinical effectiveness of individualized 3D printed artificial vertebrae in vertebral reconstruction of tuberculosis-affected spine.Methods:From May 2021 to May 2023,208 patients with spinal tuberculosis were treated in Department of Orthopedics of the Third People’s Hospital of Kunming City,among whom 15 were treated with debridement surgery and individualized 3D printed artificial vertebral reconstruction.The patients included 5 males and 10 females,aged from 31 to 72 years old(45.1±13.2)years.Lesions located at thoracic vertebra for 2 cases,at thoracolumbar spine for 2 cases,at lumbar spine for 1 case and at lumbosacral spine for 10 cases.Lesions affected 2 vertebrae in 6 cases,and more than 3 vertebrae in 9 cases.Postoperative stability of artificial vertebral body,bone ingrowth of adjacent vertebral body,preoperative and postoperative neurological changes,visual analogue scale(VAS)scores,deformity correction,and recurrence of tuberculosis were observed and analyzed.Results:All 15 patients successfully completed the operation without serious vascular and neurological complications.Among them,there were 8 cases taking anterior surgery approach,2 cases taking posterior approach and 5 cases taking combined posterior and anterior approach.The average operative time was(292.2±119.0)min,and the average intraoperative blood loss was(553.3±333.5)ml.Compared with the preoperative VAS score(5.7±0.9),average VAS scores at 7 d postoperative and at last follow up(2.9±0.5 and 1.8±0.5)declined significantly(t=9.599,P<0.001;t=13.752,P<0.001).At 1 month after surgery,one case with preoperative Frankel grade A gradually recovered to grade D,2 cases with preoperative Frankel grade B recovered to grade D,and 1 case with Frankel grade B recovered to grade C.In 2 patients underwent kyphosis correction during surgery,no loosening and displacement of the artificial vertebrae and no failure of internal fixation were observed during the follow-up.All 15 patients had no tuberculosis recurrence durin

关 键 词：结核 脊柱 骨重建 治疗结果 

分 类 号：R681.2[医药卫生—骨科学] R52[医药卫生—外科学] R81[医药卫生—临床医学]