3D打印技术在经皮椎体成形术中的临床应用

Clinical Application of Three-Dimensional Printing Technology in Percutaneous Vertebroplasty

目的探讨3D打印技术在经皮椎体成形术治疗中的可行性和临床应用价值。方法2014年2月至2015年2月共纳入64例患者行经皮椎体成形手术治疗,术前常规行X线片、CT三维重建及MRI检查。随机分成两组,对照组32例采取常规穿刺的方法,注入骨水泥;实验组32例应用3D打印技术,制作出伤椎的三维模型,明确椎体的病变部位,精准地进行经皮椎体成形术。结果 64例均获得随访,末次随访时间为术后12个月。实验组X射线暴露次数、手术时间显著低于对照组,两组间差异具有统计学意义(P<0.05)。实验组后凸Cobb角改善与对照组相比,差异无统计学意义(P>0.05);实验组30例骨水泥无或轻微渗漏,2例较明显,对照组26例骨水泥无或轻微渗漏,6例渗漏较明显,两组间差异具有统计学意义(P<0.05)。末次随访时,两组患者VAS评分、ODI评分较术前明显改善,差异具有统计学意义(P<0.05),两组间比较差异无统计学意义(P>0.05)。结论采用3D打印技术,可明确穿刺部位,及时调整穿刺路径,从而高效精准地完成经皮椎体成形术。

Objective To explore the feasibility and clinical value of three-dimensional（3D） printing technology in percutaneous vertebroplasty. Methods From February 2014 to February 2015,a total of 64 patients were selected for percutaneous vertebroplasty. The patients received X-ray,CT three-dimensional reconstruction and MRI preoperatively. They were divided into two groups randomly,with 32 cases in each. The control group was punctured and injected bone cement by the conventional method. And the experimental group was punctured under the guidance of the demonstration of the vertebral lesions through the 3D model of the injured vertebral,and then an accurate PVP was performed. Results Sixty four patients got followed up for 12 months. X-ray exposure time and operation time of the experimental group was significantly shorter than the control group（P〈0. 05）. There was no significant difference in the improved kyphotic Cobb angle between the two groups（P〉0. 05）. Cement leakage occurred in 2 of the 32 patients in the experimental group,while six cases of bone cement leakage was observed in the control group,and the difference was significant（P〈0. 05）.There were significant differences in the VAS score and ODI score between the preoperative one and the postoperative one in both two groups（P〈0. 05）,and there was no significant difference between the two groups at the end of follow-up（P〉0. 05）. Conclusion It plays an important role of the 3D printing technology in guiding the percutaneous vertebraplasty puncture,which can improve the accuracy of the PVP in the future.