Application value of 3D printing assisted pedicle screw placement in the treatment of thoracolumbar spinal fractures

Objective:To evaluate the value of 3D printing assisted pedicle screw placement in the treatment of thoracolumbar spinal fractures.Methods: 56 cases of thoracolumbar spinal fractures patients underwent 3D printing assisted pedicle screw placement (study group) and another 56 cases of thoracolumbar spinal fractures patients underwent conventional screw placement (control group) in our department from February 2016 to September 2017 were selected. Then the surgical related indicators, JOA score, the reduction of injured vertebrae and complications were recorded and compared between groups at different time points, including, before operation (T0), postoperative 1mon (T1), postoperative 6mon (T2) and postoperative 12mon (T3).Results: The operation time, intraoperative X-ray fluoroscopy frequency and intraoperative blood loss in the study group were significantly lower than those in the control group (P<0.05), meanwhile the accuracy rate of screw placement was significantly higher than that of the control group (P<0.05). JOA scores at T1, T2 and T3 in both groups were significantly higher than those at T0 (P<0.05), and JOA scores at all postoperative time points in the study group were significantly higher than those in the control group (P<0.05). Compared with T0, the ratio of the anterior and posterior border height of injured vertebrae in the two groups at T2 was significantly increased (P<0.05), while the Cobb Angle of sagittal kyphoid significantly was decreased (P<0.05). Meanwhile, the reduction of injured vertebrae in the study group was significantly better than that the control group at T2 (P<0.05). The incidence of complications in the study group was significantly lower than that in the control group (P<0.05).Conclusion: The application of 3D printing assisted pedicle screw placement in the treatment has the advantages of less injury to patients, good prognosis and high safety, which is worthy of clinical application.

3D打印技术辅助椎弓根螺钉置入治疗胸腰椎骨折的临床分析

目的比较3D打印技术与常规CT、X线辅助椎弓根螺钉治疗胸腰椎骨折的效果。方法回顾性分析我院收治的66例胸腰椎骨折患者,依据治疗方法分为2组。对照组33例,给予常规CT、X线辅助椎弓根螺钉术,观察组给予3D打印椎弓根螺钉术。比较两组围术期指标包括:手术时间、术中X线暴露次数、术中出血量、术中输血量;置钉情况(置钉数量、置钉准确数、置钉准确率)、螺钉一致性(矢状面螺钉植入角、螺钉内倾角差值、螺钉进钉点水平位置差值)、伤椎复位指标(伤椎前后高度比、矢状位后凸Cobb角)及并发症发生情况。结果观察组手术时间、术中出血量、术中X线暴露次数、术中输血量均明显低于对照组(P<0.05)。观察组置钉准确率为94.4%,明显高于对照组的74.5%(P<0.05)。观察组矢状面螺钉植入角、螺钉内倾角差值、螺钉进钉点水平位置差值均明显低于对照组(P<0.05)。治疗后,两组伤椎前后高度比均明显升高(P<0.05),矢状位后凸Cobb角均明显下降(P<0.05);且治疗半年、1年时观察组伤椎前后高度比明显高于对照组(P<0.05),矢状位后凸Cobb角明显低于对照组(P<0.05)。观察组并发症发生率为6.1%,低于对照组的12.2%(P>0.05)。结论相比于常规CT、X线,3D打印辅助椎弓根螺钉治疗胸腰椎骨折具有手术时间短、术中出血量和输血量少、辐射危害低、置钉准确率高、纠正患者脊柱畸形显著、并发症率低等优点。

CT三维重建配合3D打印技术在辅助寰枢椎椎弓根螺钉置入的应用价值评估

目的:探讨CT三维重建配合3D打印技术在辅助寰枢椎椎弓根螺钉置入的应用价值。方法:通过CT三维重建的多种后处理技术明确寰枢椎病变13例作为观察组,再将CT三维重建、逆向工程原理及快速成形技术相结合,设计出一种新型的导航模板,辅助椎弓根螺钉置入,并与13例之前已通过X线透视置钉法的病例(对照组)进行置钉效果比较。结果:对照组13例共置椎弓根螺钉41枚,其中Ⅰ类置钉9枚,Ⅱ类置钉18枚,Ⅲ类置钉14枚,成功率65.9%;观察组共打印颈椎模型13例,设计导向模板21个,5例由于先前通过X线透视仅在枢椎两侧的椎弓根内置钉,只制作出枢椎的导航模板;模拟手术同样置钉41枚,其中Ⅰ类置钉15枚,Ⅱ类置钉21枚,Ⅲ类置钉5枚,成功率87.8%。结论:CT三维重建的各种后处理技术不仅能够准确的判断寰枢椎病变,并能配合3D打印技术,制作出个体化的导航模板,使上颈椎椎弓根螺钉的置入变得既安全又省时,并能在术后准确评估置钉效果。

3D打印技术在胸腰椎骨折的椎弓根螺钉置入术中的应用效果

目的:探究3D打印技术在胸腰椎骨折的椎弓根螺钉置入术中的应用效果。方法:选取50例在本院行胸腰椎骨折的椎弓根螺钉置入术患者,将其随机分为研究组与对照组,研究组行3D打印技术辅助治疗,对照组行常规治疗。比较两组手术和术后恢复情况。结果:研究组手术时间、术中使用X线次数及术中出血量均明显低于对照组(P<0.05),且术后3个月,两组伤椎高度比及Cobb角均比术前有明显改善(P<0.05),但术后3个月两组伤椎高度比及Cobb角比较,差异均无统计学意义(P>0.05)。研究组一次性置钉成功率(96.00%)及置钉准确率(95.03%)均明显优于对照组(76.00%、80.98%),差异均有统计学意义(P<0.05)。研究组术后3个月VAS评分为(3.16±0.22)分,明显优于对照组的(3.38±0.19)分,差异有统计学意义(P<0.05)。结论:对胸腰椎骨折的椎弓根螺钉置入术中使用3D打印技术辅助治疗,能够有效提高术中置钉成功率,并降低术中X线使用频率,提高手术效率,且该治疗方法能够在保证治疗效果的同时有效降低患者术后疼痛情况,值得推广。