3D打印人工椎体辅助SRS-SchwabⅣ级截骨术治疗创伤后胸腰段后凸畸形的临床应用

Clinical application of 3D printing artificial vertebral body assisted SRS SchwabⅣosteotomy in treatment of thoracolumbar kyphosis after trauma

目的探讨3D打印人工椎体辅助SRS-SchwabⅣ级截骨术对创伤后胸腰段后凸畸形的治疗效果。方法选取2015年1月—2022年1月该院收治的创伤后胸腰段后凸畸形手术患者,按照治疗方法不同分为常规组与3D组,常规组采用常规SRS-SchwabⅣ级截骨术治疗,后者采用3D打印人工椎体辅助SRSSchwabⅣ级截骨术治疗。统计比较二组的手术情况、并发症发生率以及相关矢状面参数,并评估二组患者的疼痛缓解程度和治疗疗效。结果3D组手术时间、出血量、术中透视次数均低于常规组,首次置钉成功率高于常规组(P<0.05);术后2周和末次随访时,3D组局部后凸Cobb角减小程度大于常规组,矢状面平衡优于常规组(P<0.05)。但二组间骨盆倾斜角、骨盆入射角、骶骨倾斜角差异无统计学意义(P>0.05);术后2周和末次随访时,二组的VAS和JOA评分差异无统计学意义(P>0.05);3D组患者术后并发症发生率为5.00%,略低于常规(30.77%,P>0.05)。结论创伤后胸腰段后凸畸形患者应用3D打印人工椎体辅助SRS-SchwabⅣ级截骨术治疗疗效好,可提高首次置钉成功率,有效改善患者腰椎前凸矢状曲度,减少并发症发生,具有较高临床应用价值。

Objective To investigate the effect of SRS-Schwab classⅣosteotomy assisted by 3D printing artificial vertebral body on thoracolumbar kyphosis after trauma.Methods Select patients with post-traumatic thoracolumbar kyphosis who were treated between January 2015 to January 2022.According to different treatment methods,they were divided into conventional group and 3D group.Conventional group was treated with conventional SRS-Schwab gradeⅣosteotomy,while the latter was treated with 3D printed artificial vertebrae assisted SRS-Schwab gradeⅣosteotomy.The operation,complication rate and related sagittal plane parameters of two groups were statistically compared,and the pain relief degree and treatment effect of two groups were evaluated.Results The operation time,bleeding volume and fluoroscopy times in 3D group were lower than those in conventional group,and success rate of the first nail placement was higher than that in conventional group(P<0.05).Two weeks after operation and at the last follow-up,the reduction of local kyphosis Cobb angle in 3D group was greater than that in conventional group,and the sagittal balance was better than that in conventional group(P<0.05).However,there was no significant difference in pelvic inclination angle,pelvic incidence angle and sacral inclination angle between two groups(P>0.05).Two weeks after operation and at the last follow-up,there was no significant difference in VAS and JOA scores between two groups(P>0.05).The incidence of postoperative complications in 3D group was 5.00%,slightly lower than that in conventional group(30.77%,P>0.05).Conclusion The application of 3D printed artificial vertebrae assisted SRS-Schwab gradeⅣosteotomy in the treatment of patients with thoracolumbar kyphosis after trauma has good therapeutic effect,can improve success rate of the first nail placement,effectively improve the lumbar lordosagittal curvature of patients,and reduce the occurrence of complications,which has high clinical application value.