3D打印导航模块在胸腰椎椎弓根螺钉精准置入中的应用价值

Application value of 3D print navigation module in the precise placement of thoracic and lumbar vertebral arch screws

目的探讨基于3D打印技术的导航模块辅助置入胸腰椎椎弓根螺钉的应用效果。方法选择2019年1月~2021年5月,我院收治的胸腰椎骨折患者共70例,根据手术方法不同分为3D技术组和常规方法组,每组各35例。3D技术组采取在导航模块瞄准下置入椎弓根钉,常规方法组采取常规C臂透视下置入椎弓根钉。首先统计每例患者术中出血量、手术时间及透视的C臂次数,再依据每例患者置入椎弓根钉的数量不同,计算出置入每颗螺钉的平均出血量、时间、C臂透视次数,比较两组数据;两组患者术前均设计出理想的螺钉角度,将术后实测螺钉角度和术前设计相比较,计算出术前术后螺钉内倾角及头倾角的差值,设为偏差值,两组比较;比较两组疼痛视觉模拟评分(VAS),日本骨科协会(JOA)评估治疗评分、Oswestry功能障碍指数(ODI)、椎体高度恢复比及Cobb角的变化。结果3D技术组置入每枚螺钉出血量、所需时间、C臂曝光次数均少于常规方法组,差异显著(P<0.05);术后测得常规方法组内倾角、头倾角的偏差值大于3D技术组,差异有显著性(P<0.05);两组术后的VAS、JOA评分、ODI、椎体高度恢复比及Cobb角较术前均改善明显(P<0.05);两组术后3月的VAS、JOA评分、ODI差异不明显(P>0.05),在Cobb角和椎体高度恢复比方面,3D技术组优于常规方法组(P<0.05)。结论3D打印导航模块可辅助胸腰椎椎弓根螺钉精准置入,缩短手术时间,减少术中出血及C臂曝光次数,利于伤椎高度恢复,提高疗效。

Objective To explore the effect of 3D print-based navigation module assisted placement of thoracolumbar pedicle screws.Methods From January 2019 to May 2021,we received 70 thoracic and lumbar fracture patients,divided into 3D technical group and conventional method group according to the surgical method,with 35 patients in each group.In the 3D technology group,pedicle screws were placed under the sight of the navigation module,while in the conventional group,pedicle screws were placed under the conventional C-arm fluoroscopy.The amount of intraoperative bleeding and time of C-arm were counted in each patient.According to the different number of pedicle screw implantation in each patient,the average amount of blood loss,time and C-arm fluoroscopy times of each screw implantation were compared between the two groups.Ideal screw angles were designed for patients in both groups before surgery.Compared with the preoperative design,the difference between preoperative and postoperative screw angle and head angle was calculated and set as the deviation value.Two sets of data were compared.Visual analogue score(VAS),Japanese Orthopaedic Association(JOA)score,Oswestry disability index(ODI),vertebral height recovery ratio and Cobb's angle were compared between the two groups.Results The amount of blood loss,required time and exposure times of C-arm in 3D screw implantation group were significantly lower than those in conventional screw implantation group(P<0.05);After operation,the deviation of ininclination and head angle in the conventional method group was higher than that in the 3D technique group,and the difference was significant(P<0.05);The VAS,JOA score,ODI,vertebral height recovery ratio and Cobb's angle were significantly improved compared with the preoperative groups(P<0.05);Three months after surgery,the VAS,JOA score,and ODI were not significantly different between the two groups(P>0.05);In terms of Cobb's angle and vertebral height recovery ratio,the 3D technique group was better than the conventional method group(P<0.05).Conclusion The 3D printed navigation module can assist the precise placement of thoracolumbar pedicle screws,shorten the operation time,reduce intraoperative bleeding and c-arm exposure times,facilitate the recovery of the injured vertebral height,improve the efficacy.