3D重建技术辅助改良Wiltse入路置钉术治疗胸腰椎骨折的研究

Study on modified Wiltse approach nailing surgery assisted by 3D reconstruction technolog in treating thoracolumbar fracture

目的探讨3D重建技术辅助改良Wiltse入路置钉术在胸腰椎骨折中的应用价值。方法选取2020年1月至2022年1月该院收治的胸腰椎骨折患者50例为研究对象,按照随机数字表法分为3D重建组和对照组,各25例。3D重建组采用3D重建技术辅助改良Wiltse入路置钉术治疗,对照组采用改良Wiltse入路置钉术治疗。比较两组手术时间、术中出血量、术中透视次数、住院时间。参考Gertzbein-Robbins分类评估置钉准确性,记录一次置钉成功率,术后1 d采用CT重建测定置钉内倾角。利用视觉模拟评分法(VAS)分别在术后1、2、3 d评估患者切口疼痛情况。分别在术前及术后3、6、12个月进行Oswestry功能障碍指数(ODI)评分,并检测伤椎高度比与Cobb角,记录并发症发生情况。结果3D重建组手术时间短于对照组,术中出血量、术中透视次数少于对照组,差异均有统计学意义(P<0.05)。3D重建组置钉准确率(98.00%)高于对照组(90.00%),一次置钉成功率(89.00%)高于对照组(78.00%),差异均有统计学意义(P<0.05)。两组患者术后1、2、3 d患者的VAS评分呈下降趋势(F_(时间)=36.354,P_(时间)<0.001),两组患者术后1、2、3 d的VAS评分存在组间效应(F_(组间)=14.163,P_(组间)<0.001),两组患者VAS评分在时间和治疗方法上存在交互效应(F_(交互)=8.369,P_(交互)<0.001)。两组患者术后3、6、12个月患者的ODI评分呈下降趋势(F_(时间)=35.627,P_(时间)<0.001),两组患者术后3、6、12个月伤椎高度比、Cobb角随时间而改变(F_(时间)=18.765,P_(时间)<0.001;F_(时间)=13.654,P_(时间)<0.001)。3D重建组并发症发生率低于对照组(P<0.05)。结论3D重建技术辅助改良Wiltse入路置钉术能提升胸腰椎骨折患者的置钉准确率与一次置钉成功率,减少术中出血与透视次数,缩短手术时间,减轻术后疼痛,降低并发症发生风险。

Objective To investigate the application value of modified Wiltse approach nailing surgery assisted by 3D reconstruction technology in treating thoracolumbar fracture.Methods A total of 50 patients with thoracolumbar fractures admitted and treated in this hospital from January 2020 to January 2022 were selected and divided into the 3D reconstruction group and control group according to the random number table method,25 cases in each group.The 3D reconstruction group adopted the modified Wiltse approach nailing surgery assisted by 3D reconstruction technology,and the control group was treated with the modified Wiltse approach nailing surgery.The operation time,intraoperative blood loss amount,intraoperative fluoroscopy times and hospital stays were compared between the two groups.The accuracy of nail placement was evaluated according to the Gertzbein-Robbins classification,and the once success rate of nail placement was recorded.The CT reconstruction was used to determine the leaning angle of nail placement on 1 d after surgery.The visual analogue scale(VAS)was used to evaluate the incision pain on postoperative 1,2,3 d.The Oswestry disability index(ODI)score was performed before surgery and in postoperative 3,6,12 months.The height ratio of injured vertebra and Cobb angle were measured and the complications occurrences were recorded.Results The operation time of the 3D reconstruction group was shorter than that of the control group,and the intraoperative blood loss amount and intraoperative fluoroscopy times were lower than those of the control group,and the differences were statistically significant(P<0.05).The accuracy of nail placement in the 3D reconstruction group was 98.00%,which was higher than 90.00% in the control group,and the once success rate of nail placement in the 3D reconstruction group was 89.00%,which was higher than 78.00% in the control group,and the differences were statistically significant(P<0.05).The VAS scores on postoperative 1,2,3 d in the two groups showed a downward trend,and the difference was statistically significant(F_(time)=36.354,P_(time)<0.001).There was an intergroup effect in VAS scores on postoperative 1,2,3 d between the two groups,and the difference was statistically significant(F_(group)=14.163,P_(group)<0.001).There was an interaction effect in VAS scores in the time and treatment method between the two groups,and the difference was statistically significant(F_(interaction)=8.369,P_(interaction)<0.001).The ODI scores in postoperative 3,6 and 12 months in the two groups showed a downward trend,and the difference was statistically significant(F_(time)=35.627,P_(time)<0.001).The height ratio of injured vertebrae and Cobb angle in postoperative 3,6,12 months in the two groups changed with time,and the differences were statistically significant(F_(time)=18.765,P_(time)<0.001;F_(time)=13.654,P_(time)<0.001).The complication rate of the 3D reconstruction group was lower than that of the control group(P<0.05).Conclusion The modified Wiltse approach nailing surgery assisted by 3D reconstruction technology can increase the accuracy and once success rate of nail placement in the patients with thoracolumbar fracture,reduce intraoperative bleeding and fluoroscopy times,shorten the operation time,alleviate postoperative pain and reduce the risk of complications occurrences.