强直性脊柱炎截骨矫正3D打印导板辅助椎弓钉置入

3D printed guiders assisted pedicle screw placement in corrective osteotomy for kyphosis secondary to ankylosing spondy⁃ litis

摘要:

［目的］ 评价 3D 个体化打印导向器辅助椎弓钉置入截骨矫正强直性脊柱炎 （ankylosing spondylitis, AS） 后凸畸形的临床效果。［方法］回顾性分析本院 2014 年 6 月—2019 年 12 月手术矫正 AS 脊柱后凸畸形 70 例患者的临床资料，依据术前医患沟通结果，38 例接受 3D 打印导向器引导置钉 （3D 组），32 例接受传统方式徒手置钉 （徒手组）。比较两组围手术期情况， 随访期指标及影像结果。［结果］ 两组患者均顺利完成手术，术中无严重并发症。3D 组手术时间、术中出血量、术后引流量、 透视次数及住院时间均显著优于徒手组，差异具有统计学意义 （P<0.05）。两组患者均未发生深部感染和症状性血栓等并发症；3D 组 1 例切口积血，徒手组 1 例神经根损伤，2 例切口积血，均经对症治疗后缓解。所有患者均获随访 12~43 个月，平均 （22.47±5.84） 个月。3D 组下地行走时间、完全负重时间明显早于徒手组 （P<0.05）。与术前相比，末次随访时两组患者身高、 坐高、JOA 评分显著增加 （P<0.05），而 VAS 和 ODI 评分显著下降 （P<0.05）。末次随访时，3D 组上述指标均显著优于徒手组，差异均有统计学意义 （P<0.05）。影像方面，3D 组置钉准确率优于徒手组 （P<0.05）。与术前相比，末次随访时，两组患者矢状面后凸 Cobb 角和矢状面 C7PL 偏移均显著减少（P<0.05）。末次随访时，3D 组后凸 Cobb 角和 C7PL 偏移均显著优于徒手组（P<0.05）。［结论］对 AS 截骨矫形术中采用 3D 打印导向器可显著提高置钉效率与准确性，改善临床效果。

Abstract:

[Objective] To explore the safety and effectiveness of 3D printed guider assisted pedicle screw placement in corrective oste- otomies for kyphotic deformity secondary to ankylosing spondylitis (AS) . [Methods] A retrospective analysis was performed on 70 patients who underwent surgical correction for kyphotic deformity secondary to AS in our hospital from June 2014 to December 2019. According to the preoperative doctor-patient communication results, 38 patients received corrective osteotomies with 3D printed guiders assisted pedicle screw placements (the 3D group) , while the other 32 patients underwent surgical procedures with pedicle screw placement with the conven- tional freehand technique (the freehand group) . The documentations regarding to perioperative conditions, follow-up indicators and imag- ing results were compared between the two groups. [Results] All the patients in both groups had operation performed successfully without serious complications. The 3D group proved significantly superior to the freehand group in terms of operation time, intraoperative blood loss, postoperative drainage, intraoperative X-ray frequency and hospital stay (P＜0.05) . Although no complications, such as deep infection and symptomatic thrombosis, occurred in the two groups, incision hematoma was noted in 1 case of the 3D group and 2 cases of the free- hand group, while nerve root injury was seen in only 1 case of the freehand group, all of which were subsided after corresponding treatment. All patients were followed up for 12~43 months, with an average of (22.47±5.84) months. The 3D group resumed walking and full weightbearing activity significantly earlier than the freehand group (P＜0.05) . The body height, sitting height and JOA scores significantly in- creased in both groups (P＜0.05) , whereas the VAS and ODI scores significantly decreased in both groups at the latest follow-up compared with those before operation (P＜0.05) . At the latest follow-up, the 3D group was significantly superior to the freehand group in abovemen- tioned items (P＜0.05) . Radiographically, the 3D group got significantly better accuracy of screw placement than the freehand group (P＜ 0.05) . The sagittal kyphotic Cobb angle and the sagittal C7PL deviation significantly reduced in both groups postoperatively compared with those preoperatively (P＜0.05) , which proved significantly better in the 3D group than the freehand group at the last follow-up (P＜0.05) .[Conclusion] Application of 3D printed guider in corrective osteotomies for kyphotic deformity secondary to AS does significantly improve the efficiency and accuracy of screw placement, and improve the clinical results.