| 沈世彬,魏雪,迟巧琳,等.3D打印辅助椎弓根钉内固定治疗强直性脊柱炎合并胸腰椎骨折的临床效果.骨科,2023,14(4): 321-326. |
| 3D打印辅助椎弓根钉内固定治疗强直性脊柱炎合并胸腰椎骨折的临床效果 |
| Clinical Effect of 3D Printing Assisted Pedicle Screw Internal Fixation in the Treatment of Ankylosing Spondylitis Complicated with Thoracolumbar Fractures |
| 投稿时间：2022-10-29 |
| DOI：10.3969/j.issn.1674-8573.2023.04.005 |
| 中文关键词: 强直性脊柱炎 3D打印技术 胸腰椎骨折 椎弓根钉内固定 |
| 英文关键词: Ankylosing spondylitis 3D printing technology Thoracolumbar fractures Pedicle screw internal fixation |
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| 中文摘要: |
| 目的 探讨3D打印辅助下椎弓根钉内固定治疗强直性脊柱炎（AS）合并胸腰椎骨折的临床效果。方法 回顾性分析我院2018年8月至2020年8月收住院并进行手术治疗的15例AS合并胸腰椎骨折的病人，根据是否使用3D打印技术辅助手术分为3D组和常规组，3D组8例，常规组7例。常规组病人均选择常规手术方式，3D组病人在3D打印技术辅助下进行后入路内固定手术治疗。比较两组的手术时间、术中透视次数、术中出血量、术后引流量、置钉准确率；术后随访通过疼痛视觉模拟量表（VAS）评分和日本骨科协会评估治疗分数（JOA）评价手术疗效。结果 两组病人均顺利完成手术。3D组术中实际置入椎弓根螺钉的直径和长度以及进钉点与后正中线的距离与术前规划基本一致。3D组的置钉准确率明显高于常规组，两组比较，差异具有统计学意义（96.15% vs. 82.05%，χ2=7.988，P=0.005）；3D组的手术时间、术中透视次数、术中出血量及术后引流量均低于常规组，两组差异有统计学意义（P＜0.05）。所有病人均获得随访，随访时间为12~20个月，3D组术后1个月的VAS评分改善率明显优于常规组，两组差异有统计学意义（P＜0.05），但在术后6、12个月两组VAS评分改善率比较，差异无统计学意义（P＞0.05）；3D组在术后1、6、12个月的JOA评分改善率明显优于常规组，两组差异有统计学意义（P＜0.05）。结论 应用3D打印技术辅助下椎弓根钉内固定治疗AS合并胸腰椎骨折，能显著提高置钉准确率、减少手术时间及透视辐射伤害、提高手术效率及安全性，并且对早期减轻术后疼痛及术后腰椎功能的恢复也具有一定的促进作用。 |
| 英文摘要: |
| Objective To investigate the clinical effect of 3D printing assisted pedicle screw internal fixation in the treatment of ankylosing spondylitis (AS) complicated with thoracolumbar fractures. Methods A total of 15 patients with AS complicated with thoracolumbar fractures who were admitted into our hospital from August 2018 to August 2020 were analyzed retrospectively. According to whether 3D printing technology was used to assist surgery, they were divided into 3D group (8 cases) and routine group (7 cases). Patients in routine group were treated with routine operation, while patients in 3D group were treated with 3D printing assisted posterior internal fixation. The operation time, intraoperative perspective times, intraoperative bleeding volume, postoperative drainage volume and screw placement accuracy were compared between the two groups. Visual Analogue Score (VAS) and Japanese Orthopaedic Association Scores (JOA) were used to evaluate the surgical effect. Results The operation was successfully completed in both groups. In 3D group, the diameter and length of pedicle screws and the distance between the screw entry point and the posterior midline were basically consistent with the preoperative planning. The accuracy of screw placement in 3D group was significantly higher than that in routine group, and the difference between the two groups was statistically significant (96.15% vs. 82.05%, χ2=7.988, P=0.005). The operation time, intraoperative perspective times, intraoperative bleeding volume and postoperative drainage volume in 3D group were significantly reduced as compared with those in routine group (P＜0.05). All patients were followed up for 12-20 months. The improvement rate of VAS score in 3D group was significantly higher than that in routine group at 1st month after operation (P＜0.05), but there was no significant difference between the two groups at 6 and 12 months after operation (P＞0.05). The improvement rate of JOA score in 3D group was significantly higher than that in routine group at 1, 6 and 12 months after operation (P＜0.05). Conclusion The application of 3D printing assisted pedicle screw internal fixation in the treatment of AS complicated with thoracolumbar fractures can significantly improve the accuracy of screw placement, reduce the operation time and fluoroscopic radiation injury, improve the operation efficiency and safety, and promote the early relief of postoperative pain and the recovery of postoperative lumbar function. |
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