3D打印辅助下置钉在胸腰椎骨折患者经皮椎弓根钉内固定治疗中的应用效果  

Application effect of 3D printing-assisted underpinning in percutaneous pedicle screw internal fixation for patients with thoracolumbar fractures

作　　者：陈彦平[1] 王芳芳[1] 石家晓 苏冬冬 徐哲 魏玮 王金良 CHEN Yanping;WANG Fangfang;SHI Jiaxiao(Second Department of Spine and Spinal Cord Surgery,Cangzhou Hospital of Integrated TCM-WM·HEBEI,Hebei,Cangzhou 061001,China)

机构地区：[1]河北省沧州中西医结合医院脊柱脊髓外二科、河北省中西医结合骨关节病研究重点实验室,061001

出　　处：《河北医药》2025年第3期415-419,共5页Hebei Medical Journal

基　　金：河北省医学科学研究课题计划(编号:20220681)。

摘　　要：目的分析胸腰椎骨折患者经皮椎弓根钉内固定治疗中3D打印辅助下置钉对其脊柱功能产生的影响。方法选择2020年10月至2022年10月在河北省沧州中西医结合医院接受诊疗的胸腰椎骨折患者106例以电脑随机数表法为依据分组,对照组53例经皮椎弓根钉内固定治疗中采取透视引导下徒手置钉,观察组53例经皮椎弓根钉内固定治疗中采取3D打印辅助下置钉,比较2组患者围术期指标、置钉情况、应激反应、后凸Cobb角、伤椎前缘高度、疼痛状况及脊柱功能。结果观察组患者术中失血量与透视次数均低于对照组,术中首次准确置钉数高于对照组,手术操作时间与住院时间短于对照组(P<0.05);观察组置钉的准确率94.20%,高于对照组的64.97%(P<0.05);术后日,2组患者肌酸激酶(CK)、去甲肾上腺素(NE)及皮质醇(Cor)水平均高于术前日,但组间比较,观察组各项指标均较低(P<0.05);术后即刻、术后12个月时,观察组后凸Cobb角均低于对照组(P<0.05),术后即刻,观察组伤椎前缘高度高于对照组(P<0.05),术后12个月时,2组伤椎前缘高度比较,差异无统计学意义(P>0.05)。术后3个月、6个月、9个月及12个月时,观察组患者视觉模拟评分法(VAS)分数、Oswestry功能障碍指数(ODI)分数均低于对照组(P<0.05)。结论胸腰椎骨折患者经皮椎弓根钉内固定治疗中3D打印辅助下置钉不仅能够改善其围术期指标,提高置钉准确性,缓解应激反应,而且还能改善患者的后凸Cobb角、伤椎前缘高度、疼痛状况及脊柱功能。Objective To analyze the effect of 3D printing-assisted underpinning on the spinal function of patients with thoracolumbar fracture during percutaneous pedicle screw internal fixation.Methods A total of 106 patients with thoracolumbar fractures who were diagnosed and treated in Cangzhou Hospital of Integrated TCM-WM.HEBEI from October 2020 to October 2022 were recruited and randomly divided into the control group(53 cases received fluoroscopic guidance during percutaneous pedicle screw internal fixation)and observation group(53 cases received 3D printing-assisted underpinning in percutaneous pedicle screw internal fixation treatment).The perioperative indexes,nailing condition,stress response,kyphotic Cobb Angle,anterior edge height of injured vertebra,pain status and spinal function of the two groups were compared.Results In the observation group,the intraoperative blood loss and fluoroscopy times were significantly lower than the control group,and the number of nails accurately placed for the first time was significantly higher than the control group,and the operation time and hospitalization time were significantly shorter than those in the control group.(P<0.05).In the observation group,the accuracy of nail placement was significantly higher than that of the control group(94.20%vs 64.97%,P<0.05).On the postoperative day,the levels of creatine kinase(CK),norepinephrine(NE),and cortisol(Cor)in both groups were significantly higher than the preoperative values,but postoperative values were significantly lower in the observation group than the control group(P<0.05).Immediately after surgery and 12 months after surgery,the kyphotic Cobb angle of the observation group was significantly lower than that of the control group(P<0.05).Immediately after surgery,the anterior edge height of the injured vertebra in the observation group was significantly higher than that of the control group(P<0.05).At 12 months after surgery,the anterior edge height of the injured vertebra was comparable between the two groups(P>0.05).At 3

关 键 词：胸腰椎骨折 经皮椎弓根钉内固定 3D打印 应激反应 脊柱功能 

分 类 号：R683.2[医药卫生—骨科学]