3D打印个体化导航模板在腰椎螺钉植入中的应用效果及对患者腰椎功能应激激素的影响

Effectiveness of 3D Printed Individualized Navigation Templates in Lumbar Screw Implantation and the Effect on Patient Lumbar Spine Function and Stress Hormones

目的:探讨3D打印个体化导航模板在腰椎螺钉植入中的应用效果及对患者腰椎功能、应激激素的影响。方法:选取2019年1月至2021年1月我院122例腰椎间盘突出症及腰椎管狭窄患者,采用随机数字表法将122例患者简单随机分为两组,各61例。对照组行腰椎螺钉植入术,研究组3D打印个体化导航模板辅助下腰椎螺钉植入术。观察两组围手术期指标、手术效果、并发症,比较手术前后应激激素[过氧化氢酶(CAT)、丙二醛(MDA)、活性氧(ROS)]、脊髓功能[神经传导速度(NCV)、潜伏期(DL)]及Oswestry功能障碍指数问卷表(ODI)、视觉模拟评分法(VAS)评分。结果:研究组置钉时间短于对照组,X线机透视次数少于对照组,并发症总发生率低于对照组(P<0.05);研究组手术优良率86.89%高于对照组(72.13%,P<0.05);MDA、CAT、ROS在不同组间、不同时间的差别及分组与时间的交互作用均有统计学意义(P<0.05);研究组对MDA、CAT、ROS水平的影响小于对照组(P<0.05);NCV、DL在不同组间、不同时间的差别及分组与时间的交互作用均无统计学意义(P>0.05);ODI、VAS在不同组间、不同时间的差别及分组与时间的交互作用均有统计学意义(P>0.05),随时间变化均呈现下降趋势,研究组下降幅度大于对照组(P<0.05)。结论:3D打印个体化导航模板应用于腰椎螺钉植入中,可缩短置钉时间,降低并发症,提高手术优良率,改善腰椎功能,且对氧化应激影响较小。

Objective:To explore the application effectiveness of 3D printed individualised navigation template in lumbar screw implantation and its effect on patients'lumbar spine function and stress hormones.Methods:A total of 122 patients with lumbar disc herniation and lumbar spinal stenosis in our hospital from January 2019 to January 2021 were selected.The random number table method was used to randomly divide 122 patients into two groups,with 61 cases in each group.The control group underwent lumbar spine screw implantation,and the 3D printed individualized navigation template assisted the lower lumbar spine screw implantation in the study group.The perioperative indicators,surgical outcomes and complications in the 2 groups were observed,and the stress hormones[catalase(CAT),malondialdehyde(MDA),reactive oxygen species(ROS)],spinal cord function[nerve conduction velocity(NCV),latency(DL)]and Oswestry Dysfunction Index Questionnaire(ODI)and visual analogue scoring method(VAS)scores before and after surgery were compared.Results:The study group had a shorter nail placement time than the control group,fewer X-ray machine fluoroscopies than the control group and a lower overall complication rate than the control group(P<0.05);The rate of surgical excellence in the study group was 86.89%,higher than that in the control group(72.13%,P<0.05);The differences in MDA,CAT and ROS between groups and time and the interaction between group and time were statistically significant(P<0.05);the effect of MDA,CAT and ROS levels of the study group was smaller than that of the control group(P<0.05);There is no statistically significant differences in NCV,DL between groups,at different times and the interaction of group and time(P>0.05);(5)The differences in ODI and VAS between groups and time and the interaction between group and time were statistically significant(P>0.05),and all showed a decreasing trend over time,with a greater decrease in the study group than in the control group(P<0.05).Conclusion The application of 3D printed individualized navigation template in lumbar screw implantation reduces the nail placement time,decreases complications,increases the good rate of nail placement,improves lumbar spine function,and has less impact on oxidative stress.