3D打印人工椎体在脊柱肿瘤全椎体切除术中的疗效评价

Evaluation of the curative effect of 3D printing artificial vertebral body in total vertebral resection of spinal tumor

目的分析脊柱肿瘤全椎切除术后应用3D打印人工椎体进行脊柱重建的可行性。方法选取11例接受脊柱肿瘤全椎切除术并应用3D打印人工椎体进行脊柱重建的患者资料。记录患者手术时间、术中出血量、住院时间、内固定稳定程度,采用视觉模拟评分(VAS)对术前、术后24 h、术后6个月及末次随访的疼痛程度进行评估,并依据日本骨科协会评估治疗分数(JOA)对上述时点脊柱功能进行评估。末次随访时,采用脊髓损伤Frankel分级对脊髓损伤严重程度进行评估,随访期间记录并发症发生情况。结果全部患者随访8~15个月,平均11个月;患者手术时间(320.21±43.21)min、出血量(1354.28±101.54)mL、住院时间(22.21±10.24)d。11例患者中10例末次随访时Frankel分级有至少1个等级的改善;所有患者均未出现椎弓根钉位置移动和断裂,假体无脱位。术前、术后24 h及术后6个月的VAS评分呈依次降低趋势(P<0.01),但末次随访VAS评分与术后6个月比较差异无统计学意义;除术前与术后24 h JOA评分差异无统计学意义以外,其余各时点JOA评分呈依次升高趋势(P<0.01);1例骨巨细胞瘤患者术后3个月复发,1例脊柱继发甲状腺癌患者术后9个月死亡。结论脊柱肿瘤全椎切除术后应用3D打印人工椎体重建,稳定性高,并发症少,安全性较高,预后良好。

Objective To analyze the application value of 3 D printing artificial vertebral body for spinal cord reconstruction after total vertebrectomy for spinal tumors.Methods Data of 11 patients in our hospital who used 3 D printed artificial vertebrae for reconstruction after total vertebral tumor resection was analyzed.The operation time,intraoperative blood loss,hospital stay,internal fixation stability,and visual analogue rating scale(VAS)score were recorded.The degree of pain before operation,24 hours after operation,6 months after operation and the last follow-up were evaluated.The spinal function at the above time points was evaluated according to the evaluation treatment score of the Japanese Orthopaedic Association(JOA).At the last follow-up,the severity of spinal cord injury was analyzed by Frankel classification,and complications were recorded during the folLow-up.Results Patients were followed up for 8 to 15 months,with an average of11 months.The operation time was(320.21±43.21)min,the amount of bleeding was(1354.28±101.54)mL,and the hospital stay was(22.21±10.24)d.Ten of the 11 patients had at least 1 grade improvement in Frankel classification at the last followup.There was no movement or breakage of the pedicle screw position in all patients,and no dislocation of the prosthesis.The VAS scores shoWed a decreasing trend before surgery,24 hours after surgery,and 6 months after surgery(P<0.01);but there Was no significant difference in VAS score between the last follow-up and 6-month after surgery.There were no significant differences in JO A scores before and 24 hours after surgery,and the JO A scores showed a sequential upward trend at other time points(P<0.01).One patient with giant cell tumor of bone recurred 3 months after operation,and one patient with secondary thyroid cancer to spine died 9 months after opertion.Conclusion The application of 3 D printing artificial vertebral body after total vertebrectomy for spinal tumors has high stability,less complications,high safety and good prognosis.