3D打印钛合金骨小梁人工椎体治疗颈椎后纵韧带骨化症

Treatment of cervical ossification of posterior longitudinal ligament with titanium alloy trabecular bone three-dimensional printed artificial vertebral body

目的探讨采用3D打印钛合金骨小梁人工椎体治疗颈椎后纵韧带骨化症(ossification of posterior longitudinal ligament,OPLL)的临床疗效。方法回顾性分析2019年9月—2021年8月收治且符合选择标准的45例颈椎OPLL患者临床资料。患者均行颈前路椎体次全切除减压、椎间植骨融合、钛板内固定术,术中采用3D打印钛合金骨小梁人工椎体21例(研究组)、钛笼24例(对照组)。两组患者性别、年龄、病程、病变节段以及术前疼痛视觉模拟评分(VAS)、日本骨科协会(JOA)评分、颈椎功能障碍指数(NDI)、椎体高度、C_(2~7)Cobb角等基线资料比较,差异均无统计学意义(P>0.05)。记录两组手术时间、术中失血量以及并发症发生情况。术前及术后3、12个月,采用JOA评分、VAS评分及NDI评价患者功能及症状缓解情况;影像学检测椎体高度、C_(2~7)Cobb角,观察术后植入物下沉、椎间融合情况。结果研究组手术时间、并发症发生率均低于对照组(P<0.05),两组术中失血量差异无统计学意义(P>0.05)。患者均获随访,随访时间12~18个月;其中研究组随访时间为(14.28±4.34)个月,对照组为(15.23±3.54)个月,差异无统计学意义(t=0.809,P=0.423)。两组术后JOA评分、VAS评分和NDI均较术前改善,术后12个月较3个月改善,差异均有统计学意义(P<0.05)。术后各时间点研究组JOA评分以及术后12个月改善率均高于对照组(P<0.05),但VAS评分和NDI两组间差异均无统计学意义(P>0.05)。影像学复查示,两组术后3、12个月椎体高度、C_(2~7)Cobb角均较术前增加(P<0.05),术后3、12个月间比较差异无统计学意义(P>0.05);研究组术后各时间点椎体高度、C_(2~7)Cobb角大于对照组(P<0.05),植入物下沉少于对照组(P<0.05),但两组椎间融合差异无统计学意义(P>0.05)。结论与传统钛笼相比,采用3D打印钛合金骨小梁人工椎体治疗颈椎OPLL能缩短手术时间,减少术后并发症及植入物下沉发生,在椎体重建方面更具有优势。

Objective To evaluate the effectiveness of using titanium alloy trabecular bone three-dimensional(3D)printed artificial vertebral body in treating cervical ossification of the posterior longitudinal ligament(OPLL).Methods A retrospective analysis was conducted on clinical data from 45 patients with cervical OPLL admitted between September 2019 and August 2021 and meeting the selection criteria.All patients underwent anterior cervical corpectomy and decompression,interbody bone graft fusion,and titanium plate internal fixation.During operation,21 patients in the study group received titanium alloy trabecular bone 3D printed artificial vertebral bodies,while 24 patients in the control group received titanium cages.There was no significant difference in baseline data such as gender,age,disease duration,affected segments,or preoperative pain visual analogue scale(VAS)score,Japanese Orthopaedic Association(JOA)score,Neck Disability Index(NDI),vertebral height,and C_(2-7)Cobb angle(P>0.05).Operation time,intraoperative blood loss,and occurrence of complications were recorded for both groups.Preoperatively and at 3 and 12 months postoperatively,the functionality and symptom relief were assessed using JOA scores,VAS scores,and NDI evaluations.The vertebral height and C_(2-7)Cobb angle were detected by imaging examinations and the implant subsidence and intervertebral fusion were observed.Results The operation time and incidence of complications were significantly lower in the study group than in the control group(P<0.05),while the difference in intraoperative blood loss between the two groups was not significant(P>0.05).All patients were followed up 12-18 months,with the follow-up time of(14.28±4.34)months in the study group and(15.23±3.54)months in the control group,showing no significant difference(t=0.809,P=0.423).The JOA score,VAS score,and NDI of the two groups improved after operation,and further improved at 12 months compared to 3 months,with significant differences(P<0.05).At each time point,the study group exhibited significantly higher JOA scores and improvement rate compared to the control group(P<0.05);but there was no significantly difference in VAS score and NDI between the two groups(P>0.05).Imaging re-examination showed that the vertebral height and C_(2-7)Cobb angle of the two groups significantly increased at 3 and 12 months after operation(P<0.05),and there was no significant difference between 3 and 12 months after operation(P>0.05).At each time point,the vertebral height and C_(2-7)Cobb angle of the study group were significantly higher than those of the control group(P<0.05),and the implant subsidence rate was significantly lower than that of the control group(P<0.05).However,there was no significant difference in intervertebral fusion rate between the two groups(P>0.05).Conclusion Compared to traditional titanium cages,the use of titanium alloy trabecular bone 3D-printed artificial vertebral bodies for treating cervical OPLL results in shorter operative time,fewer postoperative complications,and lower implant subsidence rates,making it superior in vertebral reconstruction.