3D打印体外导板对经皮椎弓根螺钉固定术老年胸腰椎骨折术患者近期功能恢复的影响

Effect of 3D printed external guide plate on short-term functional recovery of elderly patients undergoing percutaneous pedicle screw fixation for thoracolumbar fractures

目的探讨3D打印体外导板对经皮椎弓根螺钉固定术老年胸腰椎骨折术患者近期功能恢复的影响。方法选择2021年3月至2022年3月河南省邓州市中心医院收治的86例老年胸腰椎骨折且符合手术条件的患者,所有患者均行经皮椎弓根螺钉固定术。将38例术前制作3D打印个体化体外导板,术前模拟置钉,术中辅助置钉的患者作为研究组,而将48例在术中采用X线透视辅助下徒手置钉的患者作为对照组。对比2组患者手术情况,术前、术后7 d胸腰椎骨折复位和矫正情况,术前、术后7 d、术后1年视觉模拟疼痛量表(VAS)、日本骨科协会(JOA)治疗评分,以及Oswestry功能障碍指数(ODI)。结果研究组患者手术时间(62±11)min、置钉时间(23±4)min均比对照组(84±15)min、(40±8)min短,X线透视次数(14±4)次比对照组(27±7)次少,出血量(49±11)ml比对照组(76±15)ml少(P均<0.05);术后1周2组患者椎体前缘高度、椎体矢状面指数相较于术前均上升,而2组患者Cobb角均下降(P均<0.05),但术后1周组间椎体前缘高度、椎体矢状面指数、Cobb角对比,差异无统计学意义(P均>0.05);术后7 d、1年2组患者VAS评分、ODI指数均比术前下降,JOA评分均比术前上升(P均<0.05),但术后7 d、1年组间VAS评分、ODI指数、JOA评分比较,差异无统计学意义(P均>0.05)。结论3D打印体外导板应用于经皮椎弓根螺钉固定术老年胸腰椎骨折术中,可使手术时间、置钉时间缩短,减少X线透视次数与出血量,有助于患者胸腰椎骨折复位和矫正情况的改善,有利于减轻患者疼痛程度,并有助于神经功能、腰椎功能的改善。

Objective To explore the impact of 3D-printed external guide plate on the short-term functional recovery of elderly patients undergoing percutaneous pedicle screw fixation for thoracolumbar fractures.Methods Admitted to Dengzhou Center Hospital in Henan Province from March 2021 to March 2022 and eligible for surgery were selected,all patients underwent percutaneous pedicle screw fixation.Thirty-eight patients who underwent preoperative 3D printed personalized external guide plates,simulated preoperative nail placement,and assisted intraoperative nail placement were selected as the study group,while 48 patients who underwent intraoperative barehanded nail placement with X-ray fluoroscopy assistance were selected as the control group.Compared the surgical outcomes of two groups of patients,including reduction and correction of thoracolumbar fractures preoperative,7 d postoperative,and 1 year postoperative,visual analog pain scale(VAS),Japanese Orthopedic Association Assessment(JOA)and treatment score,and Oswestry Dysfunction Index(ODI).Results The surgical time(62±11)minutes and nail placement time(23±4)minutes of the study group patients were shorter than those of the control group(84±15)minutes and(40±8)minutes,and the number of X-ray fluoroscopy(14±4)times was less than that of the control group(27±7)time.The amount of bleeding(49±11)ml was less than that of the control group(76±15)ml(all P<0.05);the height of the anterior margin of the vertebral body and the vertebral body sagittal plane index increased in both groups at 1 week postoperatively compared with the preoperative period,while the Cobb angle of both groups of patients decreased(both P<0.05).However,there was no significant difference in the anterior edge height,sagittal plane index,and Cobb angle between the groups at one week after surgery(all P>0.05).The VAS score and ODI index decreased and JOA score increased in both groups at 7 d and 1 year postoperatively(all P<0.05).However,there was no significant difference in VAS score when comparing the VAS score,ODI index,and JOA score between the groups at 7 d and 1 year postoperatively.Conclusion The application of 3D printed external guide plate in percutaneous pedicle screw fixation for elderly thoracolumbar fractures can shorten the surgical time and screw placement time,reduce the number of X-ray fluoroscopy and bleeding,help the patients′thoracolumbar spine fracture repositioning and correction,help to reduce the degree of patient′s pain,and contribute to the improvement of neurological function and lumbar spine function.