标杆型3D打印导板在经皮椎体成形术中的初步应用

Primary use of 3D printed guide template in percutaneous vertebroplasty

目的探讨标杆型3D打印导板在经皮椎体成形术(PVP)中的临床应用效果。方法回顾性分析2018年7月—2020年1月利川市人民医院骨科收治骨质疏松性椎体压缩骨折(OVCF)患者51例,男性16例,女性35例;年龄55~86岁,平均75.0岁。按治疗方式不同分为导板组(26例)和传统组(25例),导板组男性9例,女性17例;年龄57~86,平均75.3岁;骨密度值-3.17~-2.51SD;传统组男性7例,女性18例;年龄55~83,平均74.7岁;骨密度值-3.20~-2.50SD。导板组术前通过对CT和MRI数据融合,构建伤椎3D数字模型,设计制作个性化标杆型3D打印经皮穿刺导板,术中依靠导板辅助完成穿刺骨水泥注入手术。传统组采取常规X线透视穿刺完成骨水泥注入手术。术后两组患者均常规抗骨质疏松治疗,分别评估术前、术后1d及7d视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)及术前、术后1个月伤椎压缩比率,测量导板组术中穿刺针在椎弓根前后位及侧位透视像的位置精确度,比较两组患者手术时间(术前病椎定位、术中操作)、透视次数(术前病椎定位、术中操作),记录骨水泥渗漏及其他并发症发生情况。结果两组患者VAS、ODI及伤椎压缩比率,术后1d及7d均较术前改善,且差异有统计学意义(P<0.05)。通过术中透视像的测量评价,导板组穿刺针在前后位像上位于安全位置的为25/26(精确度96%),在侧位像上位于安全位置的为23/26(精确度88%)。导板组手术时间术前定位(3.23±0.73)min、术中操作(35.13±1.57)min,透视次数术前定位(2.31±0.43)次、术中透视(12.17±1.83)次均优于传统组(5.17±1.37)min、(46.72±1.72)min,(4.26±1.25)次、(16.57±2.52)次,P<0.05;术后1d及7d,两组患者VAS、ODI较术前均有下降,导板组VAS术后1d(2.17±1.13)分、术后7d(1.76±0.68)分,术前(6.21±1.73)分;ODI术后1d(17.80±3.23)%、术后7d(9.63±2.73)%,术前(43.65±4.37)%,传统组VAS术后1d(3.35±0.93)分、术后7d(1.58±0.73)分,术前(6.35±1.51)分;ODI术后1d(23.35±4.36)%、术后7d(10.13±2.37)%,术前(42.31±3.93)%,差异有统计学意义(P<0.05);两组患者术后伤椎压缩比率较术前均减小导板组(13.71±4.53)%vs.(34.71±3.81)%、传统组(13.32±3.27)%vs.(34.15±3.51)%,但组间比较差异无统计学意义(P>0.05)。结论标杆型3D打印导板能够缩短经皮椎体成形手术时间,减少手术透视次数,具有较好的临床推广价值。

Objective To explore the clinical effectiveness of 3D printing guide plate in percutaneous vertebroplasty(PVP).Methods A retrospective analysis of 51 patients(16 males and 35 females,55-86 years old,with an average age of 75.0 years)with osteoporotic vertebral compression fracture(OVCF)in Lichuan People s Hospital from Jul.2018 to Jan.2020 was carried out.The patients were divided into two groups based on the treatment method.In the guide plate group(GPG,n=26,9 males and 17 females;57-86 years old,with an average age of 75.3 years;bone density value-3.17--2.51SD),the puncture and bone cement injection was carried out with reference to a personalized 3D-printed guide plate,which was designed and constructed for osteoporotic vertebral based on preoperative evaluation of CT and MRI.In the traditional group(TRG,n=25,7 males and 18 females;55-83 years old,with an average age of 74.7 years;bone density value-3.20--2.50SD).The puncture and bone cement injection were undertook by conventional method.The Visual Analogue Scale(VAS),Oswestry Disability Index(ODI)preoperatively,1 day and 7 days after operation,and the anterior compression ratio of injured vertebrae(ACRIV)1 month after operation were assessed.The position accuracy of the intraoperative puncture needle in the anteroposterior and lateral fluoroscopic images of the pedicle in the guide plate group was individually measured.The operation time,the number of CT fluoroscopy,the leakage of bone cement and complications after operation were also compared.Results The VAS,ODI,and ACRIV of the two groups were improved on the 1st and 7th day after surgery compared with the preoperative state,with statistically significant differences(P<0.05).The puncture needle in the GPG in the safe position of the anteroposterior image(measured by the intraoperative fluoroscopy)was 25/26(accuracy=96%).The puncture needle in the safe position of the lateral image was 23/26(accuracy=88%).Compared with TRG,the operation time(including preoperative positioning and operation)was greatly shortened[GPG vs.TRG:preoperative positioning,(3.23±0.73)vs.(5.17±1.37)minutes;operation duration,(35.13±0.43)vs.(46.72±1.72)minutes];the times of CT fluoroscopy(including preoperative positioning and intraoperative)in the GPG was reduced[GPG vs.TRG:preoperative positioning,(2.31±0.43)vs.(4.26±1.25)times;intraoperative,(12.17±1.83)vs.(16.57±2.52)times],and the difference was statistically significant(P<0.05).Both VAS and ODI on the 1st and 7th postoperative day in GPG and TRG were reduced compared with those of preoperation.VAS in GPG on the 1st postoperative day,7th postoperative day and preoperation was(2.17±1.13)points,(1.76±0.68)points,(6.21±1.73)points,respectively;VAS in TRG on the 1st postoperative day,7th postoperative day and preoperation was(3.35±0.93)points,(1.58±0.73)points and(6.35±1.51)points,respectively,and the difference was statistically significant(P<0.05).ODI in GPG on the 1st postoperative day,7th postoperative day and preoperation was(17.80±3.23)%,(9.63±2.73)%,(43.65±4.37)%,respectively;ODI in TRG on the 1st postoperative day,7th postoperative day and preoperation was(23.35±4.36)%,(10.13±2.37)%and(42.31±3.93)%,respectively,and the difference was statistically significant(P<0.05).The ACRIV of the two groups was both decreased compared with that of preoperation(GPG:postoperation vs.preoperation:(13.71±4.53)%vs.(34.71±3.81)%,TRG:postoperation vs.preoperation:(13.32±3.27)%vs.(34.15±3.51)%.However,there was no difference in the ACRIV between the two groups.Conclusion 3D-printed guide plate can shorten the operation time,and reduce the times of intraoperative CT fluoroscopy and the incidence of postoperative complications.Our study proved that 3D-printed guide plate had high practical value.