多孔隙3D打印人工椎体在脊柱结核重建手术中的应用

Application of multi-pore 3D printed artificial vertebral body in spinal tuberculosis vertebral reconstruction

目的:观察3D打印人工椎体应用于脊柱结核椎体重建的临床结果。方法:2018年5月~2021年6月,我科连续住院手术治疗36例脊柱结核患者,其中10例采用病灶清除、3D打印人工椎体重建,包括3例定制假体,7例非定制假体;男性4例,女性6例;年龄26~73岁,中位年龄59岁。颈椎1例,胸椎4例,胸腰段2例,腰椎1例,腰骶段2例。累及3个相邻椎体2例,2个相邻椎体8例。所有患者术前接受2周正规抗结核药物化疗,根据椎体病灶大小规划手术切除范围,个体化设计假体与骨的接触面和固定模式。术后继续口服抗结核药物治疗12~18个月,每月复查血沉、血常规、肝肾功能,定期随访手术部位影像片、VAS疼痛评分、Frankel神经功能、假体融合情况、日常活动功能等。结果:平均随访20.1±9.1个月(12~45个月),手术节段角度术前为-24°~24°,末次随访时为-8°~32°,后凸改善0~32°。术前VAS评分6.4±2.6分,末次随访时为2.0±1.8分;末次随访Frankel脊髓功能分级:8例改善1级或以上,2例维持稳定;除1例耐药结核外,所有假体位置稳定,无假体松动、下沉和移位。假体融合情况Bridwell分级为Ⅰ级2例,Ⅱ级5例,Ⅲ级3例。CT评估界面融合,完全融合1例,初步融合4例,延迟融合4例,不愈合1例。结论:3D打印人工椎体用于脊柱结核具有个体化、即刻稳定性好、融合节段少的特点;临床短期随访疗效确切,假体融合情况需长期随访。

Objectives:To study the clinical outcomes of 3D printed artificial vertebrae in vertebral reconstruction of spinal tuberculosis.Methods:From May 2018 to June 2021,36 patients with spinal tuberculosis were treated surgically in our department.Among them,10 cases were treated with debridement surgery and 3D printed artificial vertebral reconstruction,including 3 cases of custom-made prosthesis and 7 cases of non-custom prosthesis.There were 4 males and 6 females,aged 26-73 years,with a median age of 59 years.Tuberculosis affected cervical spine in 1 case,thoracic spine in 4 cases,thoracolumbar spine in 2 cases,lumbar spine in 1 case,and lumbosacral spine in 2 cases.Three adjacent vertebrae were involved in 2 cases,two adjacent vertebral bodies were involved in 8 cases.All patients received anti-tuberculosis chemotherapy for 2 weeks before operation.The extent of excision was planned according to the size of lesions.The contact surface and fixation mode of prosthesis with bone were customized for individuals.Postoperative oral anti-tuberculosis drugs were given for 12-18 months.ESR,blood routine test,liver and kidney function and VAS were followed monthly.Postoperative imaging,VAS pain scales,Frankel neurological function,fusion of prosthesis,daily activity function were regularly followed.Results:All patients were followed up for 12-45 months(mean 20.1±9.1 months).The kyphosis angle of operative segment improved to-8°-32°at final follow-up from-24°-24°before operation,which improved 0-32°.The preoperative VAS pain score was 6.4±2.6,and that at the final follow-up was 2.0±1.8.Frankel classification of spinal cord function at final follow-up:8 cases improved at least 1 grade;2 cases remained stable;Except 1 case of drug resistant tuberculosis,positions of all the other prosthesis were stable without loosening,subsidence or displacement.Bridwell interbody fusion grading system:gradeⅠ,2 cases;gradeⅡ,5 cases;and gradeⅢ,3 cases.Interface fusion evaluated by CT:complete fusion in 1 case,preliminary fusion in 4 cases,delayed fusion in 4 cases,1 case of nonfusion.Conclusions:The 3D printed artificial vertebrae have the features of individualized,good immediate stability and fewer fusion segments in spinal tuberculosis.Its short-term clinical effect is definite,while the prosthesis fusion condition needs long-term follow-up.