CT结合计算机辅助设计联合3D打印在腰椎不稳症患者椎弓根螺钉双皮质固定术中的应用

Application of CT and Computer-aided Design Combined with 3D Printing in the Treatment of Pedicle Screw Bicortical Fixation in Patients with Lumbar Spine Instability

目的:探讨CT结合计算机辅助设计联合3D打印在腰椎不稳症患者椎弓根螺钉双皮质固定术中的应用效果。方法:选取2017年2月-2020年6月腰椎不稳症患者48例,采用抽签方法分为X线组和CT组,各24例。两组均给予椎弓根螺钉双皮质固定术治疗,X线组术中采用X线辅助手术治疗,CT组采用CT结合计算机辅助设计并借助3D打印技术治疗,两组术后7 d对治疗效果进行评估,比较两组腰椎活动度、腰椎功能、疼痛情况、置钉准确率及术后并发症发生率。结果:CT组治疗后7 d伤椎高度、日本骨科协会评估治疗(JOA)评分均高于X线组(P<0.05);Cobb角及VAS评分均低于X线组(P<0.05);CT组置钉准确率高于X线组(P<0.05);CT组术后感染、脑脊液漏、切口出血、内固定松动发生率低于X线组(P<0.05)。结论:CT结合计算机辅助设计联合3D打印在腰椎不稳症患者椎弓根螺钉双皮质固定术中应用能提高患者腰椎活动度及置钉准确率,降低术后并发症发生率,值得推广应用。

Objective:To investigate the application effect of CT and computer-aided design combined with 3D printing in the treatment of pedicle screw bicortical fixation in patients with lumbar spine instability.Method:From February 2017 to June 2020,48 patients with lumbar spine instability were divided into the X-ray group and the CT group by lottery,24 cases in each group.Both groups were treated with pedicle screw bicortical fixation.The X-ray group was treated with X-ray assisted surgery,and the CT group was treated with CT and computer-aided design combined with 3D printing.The effects of the two groups were evaluated 7 d after operation.Compared the lumbar spine mobility,lumbar function,pain,nail placement accuracy and postoperative complications between the two groups.Result:The height of the injured vertebrae and Japanese orthopaedic association (JOA) score in the CT group were higher than those in the X-ray group at 7 d after treatment (P<0.05).The Cobb angle and VAS score were lower than those in the X-ray group (P<0.05).The nail placement accuracy in the CT group was higher than that in the X-ray group.The incidence of postoperative infection,cerebrospinal fluid leakage,incision bleeding and internal fixation loosening in the CT group was lower than that in the X-ray group (P<0.05).Conclusion:CT and computer-aided design combined with 3D printing in the treatment of pedicle screw bicortical fixation in patients with lumbar spine instability can improve lumbar spine mobility and nail placement accuracy,and reduce the incidence of postoperative complications.It is worthy of popularization and application.