中上胸椎3D打印导板引导与徒手椎弓根钉置入比较

3D printed guide assisted versus freehand pedicle screw fixation of upper and middle thoracic spine fractures

[目的]评价3D打印导板辅助中上胸椎椎弓根钉置入准确性和意义。[方法]回顾性分析本院2019年12月-2022年12月手术治疗的中上胸椎骨折50例患者的临床资料。依据术前医患沟通结果,25例采用3D打印导板辅助置钉(导板组),25例采用传统徒手置钉(徒手组)。比较两组围手术期、随访及影像资料。[结果]50例手术均顺利完成,术中未出现主动脉、胸髓及神经根损伤。导板组透视次数[(2.8±1.2)次vs(9.5±2.7)次,P<0.001]、单钉置入时间[(2.2±0.5)min vs(3.5±0.7)min,P<0.001]、一次置钉成功率(100.0%vs 90.7%,P<0.001)均显著优于徒手组,但前者的医疗费用显著高于后者[(35221.4±423.2)元vs(34358.5±442.9)元,P<0.001]。两组手术时间、切口总长度、术中出血量、住院时间的差异均无统计学意义(P>0.05)。随访时间(16.8±3.4)个月,随时间推移,两组VAS评分、ODI指数、JOA评分及ASIA神经评级均显著改善(P<0.05),相应时间点,两组间上述指标的差异均无统计学意义(P>0.05)。术后影像评估,导板组置钉精准率[(0/I/II),(146/4/0)vs(122/23/5),P<0.001]显著优于徒手组,末次随访两组病例均骨性愈合,均无内固定物松动、断钉等。[结论]3D打印导板辅助下行中上胸椎螺钉置入,提高了椎弓根钉置入的精准性,患者射线暴露少,安全性更高。

[Objective]To evaluate the accuracy and significance of 3D printed guide assisted pedicle screw placement for fixation of the upper and middle thoracic spine fractures.[Methods]A retrospective study was performed on 50 patients who underwent surgical treat⁃ment for upper and middle thoracic spine fractures from December 2019 to December 2022.According to preoperative doctor-patient com⁃munication,25 patients had screw placed by the 3D printed guides(the guide group),while the remaining 25 patients were managed by tradi⁃tional freehand technique(the freehand group).The perioperative,follow-up and imaging data of the two groups were compared.[Results]All the 50 patients were successfully operated without injuries to aorta,thoracic pulp and nerve root.The guide group proved significantly su⁃perior to the freehand group in terms of intraoperative fluoroscopy times[(2.8±1.2)times vs(9.5±2.7)times,P<0.001],time of single screw placement[(2.2±0.5)min vs(3.5±0.7)min,P<0.001],success rate of first time screw placement(100.0%vs 90.7%,P<0.001),whereas the former consumed significantly higher medical fee than the latter[(35221.4±423.2)yuan vs(34358.5±442.9)yuan,P<0.001].However,there were no significant differences in operation time,total incision length,intraoperative blood loss and hospital stay between the two groups(P>0.05).As time went on in follow-up period lasted for(16.8±3.4)months,the VAS,ODI and JOA scores,as well as ASIA neurologi⁃cal function classification significantly improved in both groups(P<0.05),whereas which were not statistically significant between the two groups at any time points accordingly(P>0.05).As result of postoperative imaging evaluation,the guide group was also proved significantly superior to the freehand group regarding screw placement accuracy[(0/I/II),(146/4/0)vs(122/23/5),P<0.001].At the last follow-up,all patients in both groups got fracture healing without loosening of internal implants.[Conclusion]The 3D printed guide assisted pedicle screw placement for fixation of the upper and middle thoracic spine fractures does improves the accuracy with less radiation exposure and higher safety.