术前三维重建联合3D打印技术对颈椎后纵韧带骨化症手术效果的影响

Effect of preoperative three-dimensional reconstruction combined with 3D printing on the operation of ossification of posterior longitudinal ligament

目的探讨术前三维重建联合3D打印技术在颈椎后纵韧带骨化症手术中的应用效果及其对术后并发症发生率的影响。方法回顾性分析2014年6月至2017年6月间收治的43例颈椎后纵韧带骨化症患者的临床资料,根据是否采用3D打印技术辅助手术治疗分为观察组(22例)和对照组(21例)。对照组通过分析影像学检查结果,选择术式并进行手术。观察组于术前行颈椎CT检查得到薄层图像,应用mimics软件重建三维模型数据,通过3D打印机制作出颈椎3D模型,以辅助手术治疗。收集的临床资料包括手术情况(手术时间、术中出血量和住院时间),术后1周并发症情况,以及术前、术后1周、术后12个月和术后18个月的日本骨科协会评估治疗分数(JOA)和视觉模拟评分法(VAS)评分。结果观察组手术时间[(99.22±23.41)min]和术中出血量[(404.54±26.35)ml]少于对照组[(116.34±27.46)min,(421.37±28.03)ml],差异均有统计学意义(P<0.05);两组住院时间比较无统计学差异(P>0.05)。术后1周、12个月两组JOA评分无明显差异(P>0.05),术后18个月观察组JOA评分高于对照组,差异有统计学意义(P<0.05);术后1周观察组VAS评分低于对照组,差异有统计学意义(P<0.05);术后12、18个月两组VAS评分无明显差异(P>0.05)。观察组术后1周内的并发症总发生率(13.64%)明显低于对照组(42.86%),差异有统计学意义(P<0.05)。结论颈椎后纵韧带骨化症术前使用三维重建联合3D打印技术,可有效减少手术时间和术中出血量,降低术后1周并发症发生率。

Objective To observe the effect of combining preoperative three-dimensional reconstruction and 3 D printing technology on operation treatment of ossification of posterior longitudinal ligament(OPLL)and its influence on incidence of postoperative complications.Methods A retrospective analysis was performed in the clinical data of 43 OPLL patients treated from June 2014 to June 2017.According to whether 3 D printing technology was used to assist surgical treatment,the patients were divided into experimental group(n=22)and control group(n=21).In control group,the surgical approach was selected and conducted by analyzing the imaging results.In observation group,based on thin-section CT images of cervical vertebra and 3 D model data reconstructed by Mimics software and 3 D printer,3 D model of cervical vertebra was made to assist operation treatment.The operation situation(operation time,intraoperative blood loss and hospital stay),the incidence of complications during the first postoperative week,Japanese Orthopaedic Association Scores(JOA)and visual analogue scale(VAS)before operation,one week after surgery,12-,18-month after surgery were observed and compared between two groups.Results The operation time and bleeding volume in observation group were significantly lower than those in control group(P<0.05),and there was no significant difference in hospital stay between two groups(P>0.05).There was no significant difference in JOA scores at 1 week and 12 months after surgery between two groups(P>0.05),but JOA score in observation group was statistically higher than that in control group at 18 months after surgery(P<0.05).VAS score in observation group was significantly lower than that in control group at 1 week after surgery(P<0.05),and there were no significant differences in VAS scores at 12-,18-month after surgery between two groups(P>0.05).Within one week after surgery,the total incidence of complications in observation group was significantly lower than that in control group(13.64%vs 42.86%,P<0.05).Conclusion Preoperative using of 3 D reconstruction and 3 D printing to assist surgery treatment of OPLL can effectively reduce the operation time,intraoperative bleeding and the incidence of complications one week after operation.