3D打印辅助经后路椎弓根钉棒内固定对强直性脊柱炎并胸腰椎骨折患者手术应激及腰椎功能的影响

Effects of 3D printing assisted posterior pedicle screw rod internal fixation on surgical stress and lumbar function in patients with ankylosing spondylitis complicated with thoracolumbar fractures

目的探讨3D打印辅助经后路椎弓根钉棒内固定对强直性脊柱炎(AS)并胸腰椎骨折患者手术应激及腰椎功能的影响。方法选取2018年1月至2022年1月收治的72例AS并胸腰椎骨折患者为研究对象,根据随机数表法将其分为对照组(36例,经后路椎弓根钉棒内固定治疗)与观察组(36例,3D打印辅助经后路椎弓根钉棒内固定治疗)。比较两组的治疗效果。结果观察组的临床疗效优良率高于对照组(P<0.05)。观察组的手术时间短于对照组,术中出血量、术后引流量少于对照组(P<0.05)。术后1 d,两组的皮质醇(Cor)、去甲肾上腺素(NE)水平均显著升高,但观察组低于对照组(P<0.05)。术后1、3个月,两组的伤椎前缘高度比均高于术前,矢状位Cobb角均小于术前,且观察组优于对照组(P<0.05)。术后1、3个月,两组的视觉模拟评分法(VAS)、Oswestry功能障碍指数(ODI)评分均低于术前,且观察组低于对照组(P<0.05)。结论3D打印辅助经后路椎弓根钉棒内固定可缩短AS并胸腰椎骨折患者的手术时间,减少术中出血量、术后引流量,减轻手术应激反应及疼痛程度,改善伤椎前缘高度比、矢状位Cobb角,进而恢复患者的腰椎功能。

Objective To investigate the effects of 3D printing assisted posterior pedicle screw rod internal fixation on surgical stress and lumbar function in patients with ankylosing spondylitis(AS)complicated with thoracolumbar fractures.Methods A total of 72 patients with AS complicated with thoracolumbar fractures admitted from January 2018 to January 2022 were selected as the research objects.According to the random number table method,the patients were divided into control group(36 cases,treated with posterior pedicle screw rod internal fixation)and observation group(36 cases,treated with 3D printing assisted posterior pedicle screw rod internal fixation).The therapeutic effects of the two groups were compared.Results The excellent and good rate of clinical efficacy in the observation group was higher than that in the control group(P<0.05).The surgical time of the observation group was shorter than that of the control group,and the intraoperative blood loss and postoperative drainage volume were less than those of the control group(P<0.05).At 1 d after surgery,the levels of cortisol(Cor)and norepinephrine(NE)in the two groups increased significantly,but those in the observation group were lower than the control group(P<0.05).At 1 and 3 months after surgery,the height ratio of anterior edge of injured vertebrae in the two groups was higher than that before surgery,the sagittal Cobb angle was less than that before surgery,and those in the observation group were better than the control group(P<0.05).At 1 and 3 months after surgery,the scores of Visual Analogue Scale(VAS)and Oswestry Disability Index(ODI)in the two groups were lower than those before surgery,and those in the observation group were lower than the control group(P<0.05).Conclusion The 3D printing assisted posterior pedicle screw rod internal fixation can shorten the surgical time of patients with AS complicated with thoracolumbar fractures,reduce intraoperative blood loss and postoperative drainage volume,reduce surgical stress response and pain,improve the height ratio of the anterior edge of the injured vertebra and the sagittal Cobb angle,and then recover the patients'lumbar function.vertebra and the sagittal Cobb angle, and then recover the patients' lumbar function.