3D打印定向截骨导板治疗脊柱畸形的临床效果

Three-dimensional printed guider for osteotomy and instrumented fusion in surgical treatment of spinal deformity

[目的]探讨3D打印定向截骨导板技术在脊柱畸形治疗的临床效果。[方法]选择2015年11月~2017年5月在本院住院治疗的40例脊柱畸形患者为研究对象,根据手术方式不同将其分为3D组和常规组各20例,前者采用3D打印定向截骨导板法确定经椎弓根截骨融合固定,后者采用传统技术经椎弓根截骨融合固定。对比两组患者的手术时间、出血量、引流量、住院时间、畸形矫正率,采用疼痛目测类比评分法(VAS)和Oswestry功能障碍指数(ODI)评价两种方法的临床效果。[结果]3-D组手术时间[(196.67±63.38)min vs(297.34±56.81)min,P<0.05]、术中失血量[(310.21±95.28)ml vs(679.76±83.35)ml,P<0.05]、术后引流量[(298.32±56.81)ml vs(573.43±77.65)ml,P<0.05]、住院时间[(12.11±2.67)d vs(15.26±3.02)d,P<0.05]、置钉准确率[100%vs85.00%,P<0.05]和畸形矫正率[(72.51±10.23)%vs(56.14±16.07)%,P<0.05]均显著优于常规组。与术前相比,术后2个月和12个月3D组和常规组患者冠状面Cobb角均显著减少(P<0.05),VAS和ODI均显著降低(P<0.05);但相同时间点,两组间VAS和ODI的差异均无统计学意义(P<0.05)。[结论]3D打印定向截骨导板治疗脊柱畸形可缩短手术时间,减少术中出血量,提高矫正率。

[Objective] To evaluate the clinical outcomes of 3-D printed guider for osteotomy and instrumented fusion in surgical correction of spinal deformity.[Methods] From November 2015 to May 2017,40 patients underwent surgical correction of spinal deformities in our hospital.In term of operative techniques used,20 patients had the deformities corrected by 3-D printed guiders for osteotomy and instrumented fusion（the 3-D group）,whereas the remaining 20 patients received operation with conventional technique（the conventional group）.The operation time,intraoperative blood loss,drainage volume hospitalization time and corrective extent of deformities were compared between the two group,additionally,the visual analogue scale（VAS） of pain and Oswestry disability index（ODI） were used for evaluation of the consequences.[Results] The 3-D group proved statistically significantly superior to the conventional group regarding to operation time [（196.67 ± 63.38） min versus（297.34±56.81） min,P〈0.05],intraoperative blood loss [（310.21±95.28） ml versus（679.76±83.35） ml,P〈0.05],drainage volume [（298.32±56.81） ml versus（573.43±77.65） ml,P〈0.05],hospitalization time [（12.11±2.67） days versus（15.26±3.02）days,P〈0.05],accuracy of pedicle screw placement [100% versus 85.00%,P〈0.05],and corrective extent of deformity[（72.51±10.23）% versus（56.14±16.07）%,P〈0.05].Compared with those before operation,VAS,ODI and the Cobb angles on the coronal plane statistically decreased in both groups at 2 and 12 months postoperatively（P〈0.05）,despite the fact that no significant differences were noticed in VAS and ODI at anyone of corresponding time points between the two group（P〈0.05）.[Conclusion] The 3-D printed guider is an effective tool to shorten operation time,reduce blood loss and improve spinal correction in osteotomy and instrumented fusion for spinal deformities.