3D打印导板辅助经皮微创椎弓根螺钉置入治疗多节段腰椎骨折的疗效

Efficacy of 3D printing guide plate assisted percutaneous minimally invasive pedicle screw placement in the treatment of multi-segment lumbar fractures

目的探讨3D打印导板辅助经皮微创椎弓根螺钉置入治疗多节段腰椎骨折的疗效。方法选取2019年6月至2020年1月在我院行腰椎手术椎弓根螺钉内固定术的60例多节段腰椎骨折患者,根据手术方案分为对照组(n=30)和研究组(n=30),两组均采用腰椎后路椎弓根螺钉置入内固定术,对照组采用徒手椎弓根螺钉置入,研究组采用3D打印导板结合角度控制组合式椎弓根螺钉置入工具辅助治疗。比较两组围术期、腰椎功能、疼痛程度指标,记录两组不良反应发生情况,比较两组后凸Cobb角及椎体前缘高度比。结果研究组置钉时间、术中出血量、手术时间、透视时间及置钉准确率均优于对照组(P<0.05);术后3个月,两组Oswestry功能障碍指数(ODI)、疼痛视觉模拟(VAS)评分及后凸Cobb角较术前均降低,椎体前缘高度比较术前均增加,研究组ODI、VAS评分及后凸Cobb角较对照组更低,椎体前缘高度比较对照组更大(P<0.05);末次随访,两组ODI及VAS评分较术后3个月均降低(P<0.05);研究组术后后凸Cobb角均较对照组更小(P<0.05);两组并发症总发生率比较差异无统计学意义(P<0.05)。结论3D打印导板辅助经皮微创椎弓根螺钉置入治疗多节段腰椎骨折辐射小、术后恢复快,可有效提高置钉准确率,疗效良好,安全性较佳。

Objective To investigate the efficacy of 3D printing guide plate-assisted percutaneous minimally invasive pedicle screw placement in the treatment of multi-segment lumbar fractures.Methods A total of 60patients with multi-segment lumbar fractures who underwent pedicle screw internal fixation for lumbar spine surgery in our hospital from June 2019 to January 2020 were selected and divided into control group(n=30)and study group(n=30)according to the operation plan.Both groups were treated with posterior lumbar pedicle screw placement and internal fixation.Otherwise,the control group was treated with freehand pedicle screw placement,and the study group with 3D printing guide plate combined with angle control combined pedicle screw placement tool.The two groups were compared in terms of perioperative period,lumbar vertebra function,pain index,incidence of adverse reactions as well as the Cobb angle of kyphosis and the ratio of the anterior vertebral body height.Results The nail placement time,intraoperative blood loss,operation time,fluoroscopy time and accuracy of nail placement in the study group were all significantly better than those in the control group(P<0.05).At 3 months after operation,the Oswestry disability index(ODI),pain visual analogue(VAS)score and kyphotic Cobb angle in the two groups were decreased compared with those before operation,and the height of anterior vertebral body was increased compared with that before operation.The scores and Cobb angle of kyphosis were lower than those of the control group,and the height of the anterior edge of the vertebral body was higher than that of the control group(P<0.05).At last follow-up,the ODI and VAS scores of the two groups were decreased compared with 3 months after operation(P<0.05).The postoperative kyphotic Cobb angle of the study group was smaller than that of the control group(P<0.05).There was no significant difference in the total incidence of complications between the two groups(P<0.05).Conclusion 3D printing guide plate assisted percutaneous minimally invasive pedicle screw placement in the treatment of multi-segment lumbar vertebral fractures is advantageous for its less radiation and quicker postoperative recovery.It can effectively improve the accuracy of screw placement,with good curative effect and better safety.