经后路椎弓根钉棒内固定联合3D打印治疗强直性脊柱炎合并胸腰椎骨折患者的短及中期随访研究

Short-term and mid-term follow-up study of posterior pedicle screw fixation combined with 3D printing for patients with ankylosing spondylitis complicated with thoracolumbar fracture

目的探究经后路椎弓根钉棒内固定联合3D打印治疗AS合并胸腰椎骨折患者的短、中期效果。方法选取本院2014年2月至2018年2月AS合并胸腰椎骨折患者90例,按照手术方法分为两组,各45例。常规组行常规经后路椎弓根钉棒内固定治疗,3D组行经后路椎弓根钉棒内固定联合3D打印治疗。对比两组手术时间、手术出血量、术后引流量、置钉准确率、术后7 d、术后14 d、术后6个月、术后12个月日本骨科协会评估治疗分数(JOA)评分、术前、术后6个月、术后12个月后凸Cobb角、伤椎前后缘高度比后凸Cobb角、伤椎前后缘高度比。结果3D组手术时间、手术出血量、术后引流量分别为(113.14±13.85)min、(195.11±23.62)ml、(184.73±21.42)ml,均低于常规组,差异均有统计学意义(均P<0.05);3D组置钉准确率95.56%(344/360),高于常规组82.22%(296/360),差异有统计学意义(P<0.05);3D组术后7 d、术后14 d、术后6个月JOA评分分别为(20.42±2.38)分、(20.78±2.43)分、(22.47±2.69)分,均高于常规组,差异均有统计学意义(均P<0.05);术后6个月、术后12个月,3D组后凸Cobb角分别为(8.69±2.25)°、(9.08±2.50)°,均低于常规组,伤椎前后缘高度分别为(90.47±7.36)%、(90.73±7.45)%,均高于常规组,差异均有统计学意义(均P<0.05)。结论经后路椎弓根钉棒内固定联合3D打印治疗AS合并胸腰椎骨折患者,手术时间短,出血少,术后引流量低,可准确置钉,减小术后后凸Cobb角,增加伤椎前后缘高度比,促进患者胸腰椎功能恢复。

Objective To investigate the short-and medium-term effects of posterior pedicle screw fixation combined with 3D printing in the treatment of patients with ankylosing spondylitis(AS)and thoracolumbar fractures.Methods Ninety patients with AS and thoracolumbar fractures treated in our hospital from February,2014 to February,2018 were selected,and were divided into a routine group and a 3D group,with 45 cases in each group.The routine group was treated with posterior pedicle screw fixation,and the 3D group with posterior pedicle screw fixation and 3D printing.The operation time,surgical bleeding volume,postoperative drainage volume,accuracy of nail placement,and Japanese Orthopaedic Association evaluated the treatment score(JOA),convex Cobb angles,anterior and posterior edge heights of the injured vertebrae,kyphosis Cobb angles,and heights of the anterior and posterior margin of the injured vertebrae 1 week,2 weeks,6 months,and 12 months after the operation were compared between these two groups.Results The operation time,surgical bleeding volume,and postoperative drainage volume were(113.14±13.85)min,(195.11±23.62)ml,and(184.73±21.42)ml in the 3D group,which were lower than those in the routine group(all P<0.05).The accuracy of nail placement was 95.56%(344/360)in the 3D group,and was 82.22%(296/360)in the routine(P<0.05).The JOA scores 1 week,2 weeks,and 6 months after the operation were(20.42±2.38),(20.78±2.43),and(22.47±2.69)in the 3D group,which were higher than those in the routine group(all P<0.05).6 and 12 months after the operation,the kyphosis Cobb angles were(8.69±2.25)°and(9.08±2.50)°,which were lower in the 3D group than in the routine group;and the heights of the anterior and posterior margin of the injured vertebra were(90.47±7.36)%and(90.73±7.45)%,which were higher than those in the routine group(P<0.05).Conclusions Posterior pedicle screw fixation combined with 3D printing for patients with AS and thoracolumbar fractures has short operation time,less bleeding,low postoperative drainage,accurate nail placement,and reduced postoperative kyphosis Cobb angle.The height ratio of the anterior and posterior margin of the injured vertebrae promotes the recovery of thoracolumbar function.