个性化3D打印导板辅助重度脊柱后凸畸形手术矫正  

Individualized 3D printing guide plates-assisted surgical correction for severe kyphosis deformity

作　　者：彭元昊 成凯 朱浩天 王虹 刘康 王宇宁 丁焕文 吴毅[4] PENG Yuanhao;CHENG Kai;ZHU Haotian;WANG Hong;LIU Kang;WANG Yuning;DING Huanwen;WU Yi(School of Medicine of South China University of Technology,Guangzhou,Guangdong Province,510000;Department of Orthopedic Surgery,Guangzhou First People’s Hospital,Guangzhou,Guangdong Province,510000;Department of Rehabilitation Medicine,General Hospital of Chinese PLA Southern Theater Command,Guangzhou,Guangdong Province,510000;Institute of Digital Medicine,Faculty of Biomedical Engineering and Imaging Medicine,Army Medical University(Third Military Medical University),Chongqing,400038,China)

机构地区：[1]华南理工大学医学院,广州510000 [2]广州市第一人民医院骨科,广州510000 [3]中国人民解放军南部战区总医院康复医学科,广州510000 [4]陆军军医大学(第三军医大学)生物医学工程与影像医学系数字医学教研室,重庆400038

出　　处：《陆军军医大学学报》2024年第21期2443-2450,共8页Journal of Army Medical University

基　　金：国家重点研发计划(2019YFE0126300,2021YFB3800800);广东省自然科学基金面上项目(2021A1515012564,2023A1515010557);广州市重点研发计划(202206040001)。

摘　　要：目的评估在个性化3D打印导板引导下,行经椎体内截骨术、脊柱内固定术治疗重度脊柱后凸手术的矫形率、椎弓根钉位准确性和治疗效果。方法本研究为单中心非随机性临床试验研究,样本涵盖2018年12月至2023年6月期间接受经椎体内截骨术的19例患者(男性8例,女性11例)。其中7例患者为导板组,采用计算机辅助设计(CAD)技术进行术前手术规划和术中个性化3D打印导板引导,12例患者为传统组,采用传统置钉矫正。术后评估包括后凸Cobb角、脊柱矫正率、钉位准确性和Oswestry功能障碍指数问卷调查(Oswestry Dysfunction Index,ODI)。结果研究纳入患者19例,平均年龄48.0岁。平均随访26.4(9~54个月)。所有患者均获得相对满意的矫正效果,导板组平均矫正率为96.83%,传统组为86.61%。导板组与传统组平均术中出血量(857 vs 1045 mL)和平均手术时间(344 vs 402 min)差异无统计学意义,平均住院时间(11 vs 18 d)差异具有统计学意义(P<0.05)。本研究共置钉278枚,其中导板辅助置钉70枚,97.1%为A级或B级;传统组置钉208枚,其中93.8%为A级或B级。术后CT/X线检查显示导板组与传统组后凸畸形矫正均达到一定程度矫正,2组的平均矫正角度(43.37°vs 36.10°)差异无统计学意义;而导板组的矫正率显著高于传统组(96.83%vs 86.61%,P<0.01);ODI评分导板组显著低于传统组(P<0.05)。结论在脊柱截骨术中,利用计算机辅助技术进行术前规划、手术模拟和个性化3D打印导板的辅助,能够改善术后矫形率,提高置钉的准确性,改善严重脊柱后凸畸形患者的生活质量。Objective To evaluate the correction rate,accuracy of pedicle screw fixation and overall clinical efficacy of intravertebral osteotomy and internal fixation surgery with the assistance of 3D printing guide plates in treatment of severe kyphosis.Methods A single-center nonrandomized clinical pilot study was conducted on 19 patients(8 males and 11 females)with severe kyphosis undergoing intravertebral osteotomy between December 2018 and June 2023.Seven of them(CAD group)had preoperative planning with computer-aided design(CAD)and intraoperative guidance of individualized 3D printing guide plates.And another 12 patients(control group)were corrected with conventional pedicle screw placement.Postoperative evaluation included assessment of posterior Cobb angle,spinal angular correction rate,accuracy of pedicle screw placement and Oswestry Dysfunction Index(ODI)questionnaire.Results The 19 patients were at a mean age of 48.0 years,and followed up for 26.4(9~54)months.All of them achieved relatively satisfactory corrective results,with those of the CAD group having a correction rate of 96.83%and those of the control group of 86.61%.There were no statistical differences in average intraoperative blood loss(857 vs 1045 mL)and average operative time(344 vs 402 min),but significant difference was observed in average length of hospital stay(11 vs 18 d,P<0.05)between the 2 groups.A total of 278 nails were placed in this study,including 70 guide-assisted pedicle screws,97.1%of which were grade A or B.In the control group,208 pedicle screws were placed,93.8%of which were grade A or B.Postoperative CT/X-ray scanning displayed that both groups achieved certain correction for kyphosis.No obvious difference was found in the average spinal angular correction(43.37°vs 36.10°),and significantly higher correction rate was seen in the CAD group than the control group(96.83%vs 86.61%,P<0.01).The ODI value was notably lower in the CAD group than the control group(P<0.05).Conclusion CAD-assisted preoperative planning,surgical simulation a

关 键 词：脊柱后凸 导板 3D打印 计算机辅助设计 病例系列 

分 类 号：R319[医药卫生—基础医学] R682.13R687.32