3D打印辅助SRS-Schwab Ⅳ级截骨术治疗退变性腰椎后凸畸形

3D Printing Assisted SRS-Schwab Ⅳ Osteotomy for Degenerative Lumbar Kyphosis

目的探讨3D打印辅助SRS-SchwabⅣ级截骨术治疗退变性腰椎后凸畸形(LDK)的临床效果。方法回顾性分析2016年6月~2020年6月于郑州大学第一附属医院住院接受手术治疗的LDK患者。根据手术方式的不同将其分为实验组和对照组各22例,实验组采用3D打印辅助SRS-SchwabⅣ级截骨术,对照组根据术前影像学资料行SRS-SchwabⅣ级截骨术。对比两组患者的手术时间、放射暴露时间、出血量、腰椎前凸矫正度数、腰椎前凸矫正丢失率、矢状面平衡,使用疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评价两种方法的临床效果。结果实验组手术时间、放射暴露时间及出血量低于对照组,差异有统计学意义(P<0.05)。实验组腰椎前凸矫正度数高于对照组,差异有统计学意义(P<0.05);两组间腰椎前凸丢失率比较,差异无统计学意义(P>0.05);在术后两周和末次随访时,实验组矢状面平衡均小于对照组,差异有统计学意义(P<0.05)。相同时间点,两组间VAS和ODI比较,差异均无统计学意义(P>0.05)。结论3D打印辅助SRS-SchwabⅣ级截骨术治疗LDK具有可行性,矫形效果良好,腰椎前凸矢状曲度恢复效果佳,可以减少手术时间、术中出血量及放射暴露时间,具有临床应用价值。

Objective To explore the clinical effect of 3D printing assisted SRS-SchwabⅣosteotomy for degenerative lumbar kyphosis.Methods A retrospective analysis of LDK patients who were hospitalized for surgery in the First Affiliated Hospital of Zhengzhou University from June 2016 to June 2020 was performed.According to different surgical methods,they were divided into experimental group and control group with 22 cases each.The subjects in experimental group used 3D printing assisted SRS-SchwabⅣosteotomy,and those in the control group underwent SRS-SchwabⅣosteotomy based on preoperative imaging data.The operation time,radiation exposure time,intraoperative blood loss,lumbar lordosis correction degree,lumbar lordosis correction loss rate and sagittal vertical axis were compared between the two groups.The pain visual analog scale(VAS)and Oswestry dysfunction index(ODI)were used to evaluate the clinical effects of the two methods.Results The operation time,radiation exposure time and blood loss in the experimental group were lower than those in the control group,and the differences were statistically significant(P<0.05).The correction degree of lumbar lordosis in the experimental group was higher than that in the control group,and the difference was statistically significant(P<0.05).The difference of lumbar lordosis loss rate between the two groups was not statistically significant(P>0.05).At 2 weeks after surgery and at the last follow-up,the sagittal vertical axis of the experimental group was smaller than that of the control group,and the difference was statistically significant(P<0.05).At the same time point,there was no significant difference in VAS score and ODI index between the two groups(P>0.05).Conclusion 3D printing assisted SRS-SchwabⅣosteotomy is feasible for the treatment of LDK,the orthopedic effect is good,and the sagittal curvature of lumbar lordosis is restored well.It can reduce the operation time,intraoperative blood loss and radiation exposure time,which has clinical application value.