3D打印及导航导板技术在腰椎滑脱手术中的应用价值

Application value of 3D printing and navigation plate technique in the operation of lumbar spondylolisthesis

目的探讨3D打印及导航导板技术在腰椎滑脱手术中的临床应用价值。方法选取2015年1月至2017年4月期间禅城区中心医院脊柱外科收治的70例腰椎滑脱患者为研究对象,根据随机数表法分为观察组和对照组,每组35例,所有患者均接受腰椎椎弓根螺钉置入术治疗,其中对照组根据三维CT重建图像制定手术方案,观察组采用3D打印技术制定手术方案,比较两组患者围手术期临床指标,并在术前及术后6个月评价疼痛程度(VAS评分)及采用日本骨科学会评分(JOA)评价临床疗效。结果观察组患者的椎弓根置入时间、穿刺次数、术中出血量分别为(5.5±1.4)min、(1.2±0.3)次、(203.2±35.5)m L,均明显少于对照组的(8.4±1.6)min、(1.8±0.5)次、(256.7±40.2)m L,且其穿刺准确率为94.29%,明显高于对照组的82.35%,差异均有统计学意义(P<0.05);术后6个月,观察组与对照组患者的VAS评分分别为(2.3±0.7)分、(2.6±0.9)分,明显低于术前的(7.1±1.4)分和(7.2±1.7)分,JOA评分分别为(23.8±6.9)分和(22.7±6.4)分,明显高于术前的(10.2±2.8)分和(9.8±3.0)分,差异均有统计学意义(P<0.05);两组患者间VAS评分、JOA评分比较差异无统计学意义(P>0.05)。结论 3D打印及个体化导航模板辅助腰椎椎弓根螺钉置入术不仅疗效确切,且有利于椎弓根螺钉的准确置入,减少出血量,缩短了手术时间。

Objective To investigate the application value of 3D printing and navigation plate technique in the operation of lumbar spondylolisthesis.Methods Seventy patients with lumbar spondylolisthesis treated in Department of Spinal Surgery,Foshan Chancheng District Central Hospital from January 2015 to April 2017 were selected as the research objects.According to the random digital table method,they were divided into the observation group and the control group,with 35 cases in each group.All patients were treated with lumbar pedicle screw placement.The control group made the operation plan according to the 3D CT reconstruction image,and the observation group made the operation plan with 3D printing technology.The perioperative clinical indexes were compared between the two groups.The clinical efficacy at preoperative and postoperative 6 months were evaluated by Visual pain simulation score（VAS） and Japanese Orthopedic Association score（JOAA）.Results The pedicle placement time,intraoperative puncture times,bleeding in observation group were respectively（5.5 ± 1.4） min,（1.2 ± 0.3）,（203.2 ± 35.5） m L,which were significantly less than（8.4 ± 1.6） min,（1.8 ± 0.5）,（256.7 ± 40.2） m L in the control group.The puncture accuracy rate in observation group was 94.29%,which was significantly higher than 82.35% in the control group（P〈0.05）.Six months after operation,the VAS score in observation and the control group were respectively（2.3±0.7）,（2.6±0.9）,which were significantly lower than（7.1±1.4） and（7.2±1.7） before operation,and JOA scores were（23.8±6.9） and（22.7±6.4）,which were significantly higher than（10.2±2.8） and（9.8±3.0） before operation（P〈0.05）.There was no significant difference in VAS score and JOA score between the two groups（P〈0.05）.Conclusion 3D printing and individualized navigation plate has definite efficacy for lumbar pedicle screw placement,and it is beneficial to the accurate placement of pedicle screws,with the advantages of reducing the amount of bleeding and shortening the operation time.