3D打印技术辅助后路植骨联合后路椎弓根内固定对脊柱侧弯患者炎症-应激因子、腰椎功能及生存质量的影响

Effects of 3D printing technology assisted posterior bone grafting combined with posterior pedicle internal fixation on inflammatory stress factors,lumbar function and quality of life in patients with scoliosis

目的探讨3D打印技术辅助后路植骨联合后路椎弓根内固定对脊柱侧弯患者炎症-应激因子、腰椎功能及生存质量的影响。方法选取2021年1月至2023年1月南阳信臣中医院收治的60例脊柱侧弯患者,电脑随机分为两组,每组各30例。对照组采用后路椎弓根内固定,联合组采用3D打印技术辅助后路植骨联合后路椎弓根内固定。对比两组手术相关指标、Oswestry功能障碍指数(ODI)、视觉疼痛模拟VAS评分、应激因子[血清肌酸激酶(CK)、去甲肾上腺素(NE)、皮质醇(Cor)水平]、腰椎功能[胸腰段后凸角(TLK)、胸椎后凸角(TK)、腰椎前凸角(LL)]。结果联合组术中出血量、透视次数、住院天数少于对照组,手术时间长于对照组,差异有统计学意义(P<0.05);两组术后1个月ODI、VAS评分明显降低,其中联合组降低幅度大于对照组,差异有统计学意义(P<0.05);两组术后3 d Cor、NE、CK水平显著升高,其中联合组升高幅度小于对照组,差异有统计学意义(P<0.05);联合组术后两周TLK、TK、LL改善幅度大于对照组,差异有统计学意义(P<0.05)。结论3D打印技术辅助后路植骨联合后路椎弓根内固定在治疗脊柱侧弯患者中,能改善腰椎功能、减轻应激反应、提高生活质量,但手术时间较长。

【Objective】To investigate the effects of 3D printing technology assisted posterior bone grafting combined with posterior pedicle internal fixation on inflammatory stress factors,lumbar function and quality of life in patients with scoliosis.【Methods】Sixty patients with scoliosis admitted in Xinchen Traditional Chinese Medicine Hospital from January 2021 to January 2023 were randomly divided into two groups with 30 cases in each group.The control group was treated with posterior pedicle internal fixation,and the combined group was treated with 3D printing technology assisted with posterior bone grafting and posterior pedicle internal fixation.Surgery related indexes,Oswestry disability index(ODI),Visual Analogue Scale(VAS)score for pain,stress factors[serum creatine kinase(CK),norepinephrine(NE),cortisol(Cor)levels],lumbar function[thoracolembar kyphosis(TLK)angle,thoracic kyphosis(TK)angle,lumbar lordosis(LL)angle]were compared between the two groups.【Results】The amount of blood loss,fluoroscopy times and hospitalization days in the combined group were less than those in the control group,and the operation time was longer than that in the control group,the difference was statistically significant(P<0.05).ODI and VAS scores of the two groups were significantly decreased one month after operation,and the reduction range of the combined group was greater than that of the control group,the difference was statistically significant(P<0.05).The levels of Cor,NE and CK in the two groups were significantly increased 3 days after surgery,and the increases in the combined group were lower than those in the control group,with statistical significance(P<0.05).Two weeks after operation,the improvement of TLK,TK and LL in the combined group was greater than that in the control group,and the difference was statistically significant(P<0.05).【Conclusion】3D printing assisted posterior bone grafting combined with posterior pedicle fixation can improve lumbar function,reduce stress response and improve quality of life in patients with scoliosis,but the operation time is longer.