3D打印预置钉道模型辅助下腰骶部半椎体畸形矫形手术的疗效分析  

Efficacy analysis of 3D printing prefixed nail path model assisted lumbar and sacral hemivertebra orthopaedic surgery

作　　者：吴肖南 胡巍然 马浩浩 高延征 施新革 王红强 廖文胜 WU Xiao-nan;HU Wei-ran;MA Hao-hao;GAO Yan-zheng;SHI Xin-ge;WANG Hong-qiang;LIAO Wen-sheng(Surgery Department of Spinal and Spinal Cord,Henan University People's Hospital,Henan Provincial People's Hospital,Zhengzhou 450003,Henan,China)

机构地区：[1]河南大学人民医院河南省人民医院脊柱脊髓外科,河南郑州450003

出　　处：《中国骨伤》2024年第11期1113-1119,共7页China Journal of Orthopaedics and Traumatology

基　　金：河南省医学科技攻关计划项目(编号:SBGJ202102024)。

摘　　要：目的:分析3D打印预置钉道模型辅助腰骶部半椎体畸形矫形手术的安全性和有效性。方法:回顾性分析2016年1月至2021年7月收治的8例腰骶部半椎体畸形患者,男3例,女5例,手术时年龄6~15岁,半椎体位于左侧4例,位于右侧4例;半椎体位于L2,3节段1例,L3,4节段2例,L4,5节段2例,L5S1节段3例;完全分节半椎体4例,不完全分节半椎体4例。将患者CT数据导入Mimics 21.0软件进行建模,随后将模型数据导入3-Matic软件,选择需要置钉的椎体模拟出最佳的螺钉置入角度及长度,打印模型进行术前规划及术中导引。所有患者均在3D打印预置钉道模型辅助下行矫形手术治疗,通过比较患者的影像学参数评价3D打印预置钉道模型辅助腰骶部半椎体矫形手术的安全性和有效性。主要观察指标为患者术前、术后1周及术后1年主弯Cobb角、近端代偿弯Cobb角、C7中心至骶骨中垂线(C7plumb line-center sacral vertical line,C7PL-CSVL)以及置钉准确率、侧凸矫正率。结果:8例患者获随访,时间13~31个月;共置入椎弓根螺钉98枚,椎弓根螺钉置钉的等级A、B、C、D、E级螺钉的数目依次为38、46、10、4、0枚,以A、B级螺钉定义为螺钉位置良好,置钉准确率为85.7%(84/98)。8例患者主弯Cobb角术前21°~38°,术后1周5°~11°,术后1年7°~12°;近端代偿弯Cobb角术前16°~39°,术后1周7°~12°,术后1年7°~14°;矫正效果保持良好,无矫正丢失。冠状位平衡指标C7PL-CSVL术前20~35 mm,术后1周11~18 mm,术后1年10~16 mm,患者冠状面失衡情况有所改善。侧凸矫正率术后1周65.6%~84.2%,术后1年61.9%~81.6%。结论:在腰骶部半椎体截骨矫形术中使用3D打印预置钉道模型安全有效,可明显改善患者局部畸形,是辅助腰骶部半椎体截骨矫形手术的一种可靠方法。Objective To analyze the safety and effectiveness of 3D printing prefabricated nail path model assisted lumbosacral hemivertebra orthopaedic surgery.Methods A retrospective analysis was performed on 8 patients with lumbosacral hemivertebra deformity admitted from January 2016 to July 2021,including 3 males and 5 females,aged 6 to 15 at the time of surgery.The hemivertebra of 4 cases located on the left side and 4 cases on the right side.The hemivertebra of 1 case located at L2,3,2 cases at L3,4,2 cases at L4,5,and 3 cases at L5S1.Four cases were fully segmented hemivertebra and 4 cases were incomplete segmented hemivertebra.The patient CT data was imported into Mimics 21.0 software for modeling,and then the model data was imported into 3-Matic software.The vertebra requiring screw placement was selected to simulate the optimal screw placement angle and length,and the model was printed for preoperative planning and intraoperative guidance.All patients underwent orthopedic surgery with the aid of 3D printing preset nail path model.The safety and effectiveness of the 3D printing prefabricated nail tunnel model assisted lumbosacral hemivertebra orthopaedic surgery was evaluated by comparing the imaging parameters of the patients.The main outcome measures were the Cobb angle of the main curve,the Cobb angle of the proximal compensatory curve,the coronal balance index C7 plumb line-center sacral vertical line(C7PL-CSVL),the accuracy of nail placement,and the correction rate of scoliosis before surgery,1 week and 1 year after surgery.Results All of 8 patients were followed up for 13 to 31 months.A total of 98 pedicle screws were placed in 8 patients.The number of pedicle screw grades A,B,C,D,E was 38,46,10,4,0 screws.The screws of grade A and B were defined as good position,the accuracy rate of screw placement was 85.7%.The Cobb angle of the main curve were 21°to 38°before operation,5°to 11°at 1 week after operation,7°to 12°at 1 year after operation.The Cobb angle of the proximal compensatory curve were 16°to 39�

关 键 词：3D打印 预置钉道模型 腰骶部半椎体畸形 矫形手术 

分 类 号：R681.5[医药卫生—骨科学]