基于3D打印的椎弓根螺钉置钉技术治疗胸腰段脊柱骨折的应用价值研究

Value of pedicle screw fixation technology based on 3D printing in the treatment of thoracolumbar spinal fractures

目的:探讨3D打印技术在椎弓根螺钉置钉技术治疗胸腰段脊柱骨折的应用价值。方法:选择2016年2月～2017年9月我科采用3D打印的椎弓根螺钉置钉技术治疗56例胸腰段脊柱骨折患者,作为研究组,另外选择同期采用常规方法置钉治疗的胸腰段脊柱骨折患者56例,作为对照组。对比两组患者手术相关指标,分别于术前(T0)、术后1个月(T1)、6个月(T2)、12个月(T3)评估腰椎JOA评分,同时分别于T0和T2评估患者伤椎复位情况,另外观察患者的并发症情况。结果:与对照组相比,研究组患者的手术时间、术中X线透视次数和术中出血量均明显降低(P<0.05),而置钉准确率显著高于对照组(P<0.05);两组患者T1、T2及T3时JOA评分均明显高于T0(P<0.05),同时研究组患者术后各时间点JOA评分均显著高于对照组(P<0.05);与T0相比,两组患者T2时伤椎前后缘高度比明显升高(P<0.05),而矢状位后凸Cobb角显著降低(P<0.05),同时研究组患者T2时伤椎复位情况明显优于对照组(P<0.05);研究组并发症发生率明显低于对照组(P<0.05)。结论:采用3D打印技术辅助椎弓根螺钉置钉术治疗胸腰段脊柱骨折手术效果明显,对患者损伤小,预后效果好,安全性高,值得在临床上推广应用。

Objective: To evaluate the value of 3D printing in the treatment of thoracolumbar spinal fractures with pedicle screw fixation. Methods: A total of 56 cases of patients with thoracolumbar spinal fractures that were treated by pedicle screw placement technology with 3D printing from February 2016 to September 2017 in our department were enrolled as the research group. And 56 cases of patients with thoracolumbar spinal fractures treated with conventional screw placement during the same period were selected as the control group. The JOA score of the lumbar spine was evaluated preoperatively (T0), 1 month postoperatively (T1), 6 months postoperatively (T2), and 12 months postoperatively (T3). Meanwhile, the reduction of injured vertebrae was evaluated at T0 and T2 respectively, and complications were observed too. Results: Compared with the control group, the operation time, intraoperative X-ray fluoroscopy frequency and intraoperative blood loss of the patients in the study group significantly reduced ( P <0.05), while the accuracy of screw placement was significantly higher than that of the control group ( P <0.05). JOA scores at T1, T2 and T3 in both groups were significantly higher than those at T0 ( P <0.05), and JOA scores at all postoperative time points in the study group were significantly higher than those in the control group ( P <0.05). Compared with T0, the ratio of the anterior and posterior margins of injured vertebrae in the two groups at T2 significantly increased ( P <0.05), while the Cobb Angle of sagittal kyphoid significantly decreased ( P <0.05). Meanwhile, the reduction of injured vertebrae in the study group was significantly better than that the control group at T2 ( P <0.05). The incidence of complications in the study group was significantly lower than that in the control group ( P <0.05). Conclusion: The application of 3D printing technology in the treatment of thoracolumbar spinal fracture assisted by pedicle screw fixation shows obvious effects, less injury to patients, good prognosis and high safety, which is worthy of clinical application.