3D打印辅助截骨器械矫正强直性脊柱炎后凸畸形

3D printing assisted osteotomy and instrumented correction of kyphosis secondary to ankylosing spondylitis

摘要:

［目的］评价 3D 打印辅助截骨器械矫正强直性脊柱炎（ankylosing spondylitis, AS）后凸畸形的临床效果。［方法］回顾性分析 2015 年 12 月—2020 年 12 月本院 AS 后凸畸形手术矫正的 47 例患者的临床资料。根据医患沟通结果，19 例采用 3D 打印辅助手术（3D 组），28 例采用常规徒手手术（常规组）。比较两组围手术期、随访和影像资料。［结果］两组患者均顺利完成手术，无死亡、截瘫等严重并发症。3D 组手术时间、切口总长度、术中出血量、术中透视次数、异体输血量、术后 2 d Hb、住院时间均显著优于常规组（P<0.05），但是，两组切口愈合等级的差异无统计学意义（P>0.05）。两组患者随访（27.7±3.3）个月。 3D 组恢复完全负重活动显著早于常规组（P<0.05）。随时间推移，两组 ADL、VAS、ODI 和 JOA 评分均显著改善（P<0.05）。术后 3 个月和末次随访时，3D 组的 ADL、VAS、ODI 和 JOA 评分均显著优于常规组（P<0.05）。影像方面，术后 3D 组置钉准确率显著优于常规组（P<0.05）。与术前相比，术后 3 个月和末次随访时，两组矢状面主弯 Cobb 角、矢状面平衡偏移、冠状面主弯 Cobb 角、冠状面平衡偏移均显著改善（P<0.05），术后 3 个月和末次随访时 3D 组上述影像指标均显著优于常规组（P<0.05）。［结论］ 3D 辅助截骨器械矫正 AS 脊柱畸形可显著提高置钉准确率，减少手术时间、降低手术创伤、改善临床效果。

关键词:强直性脊柱炎;后凸畸形;3D 打印;截骨术;器械矫正

Abstract:

[Objective] To evaluate the clinical outcomes of 3D printing assisted osteotomy and instrumented correction of kyphosis sec- ondary to ankylosing spondylitis (AS) . [Methods] A retrospective study was done on 47 patients who received surgical correction of kyphosis secondary to AS kyphosis in our hospital from December 2015 to December 2020. According to the results of doctor-patient communication, 19 patients underwent 3D print- assisted surgery (3D group) , and 28 patients underwent conventional freehand surgery (conventional group) . The documents regarding to perioperative period, follow-up and radiographs were compared between the two groups. [Results] All patients in both groups had operation finished successfully without death, paraplegia and other serious complications. The 3D group proved significantly superior to the conventional group in terms of operation time, total incision length, intraoperative blood loss, intraoperative fluo- roscopy times, amount of allogenic blood transfusion, postoperative hemoglobin (Hb) at 2 days, and hospital stay (P＜0.05) , nevertheless there was no significant difference in incision healing grade between the two groups (P＞0.05) . All of them in both groups were followed up for (27.7±3.3) months, and the 3D group returned to full weight-bearing activity significantly earlier than the conventional group (P＜0.05) . The ADL, VAS, ODI and JOA scores improved significantly over time in both groups (P＜0.05) , which in the 3D group were significantly better than those in the conventional group at 3 months and the latest follow- up (P＜0.05) . Regarding imaging, the accuracy of pedicle screw placement in the 3D group was significantly better than that in the conventional group (P＜0.05) . The Cobb angles of the main curva- ture and balance deviations in both sagittal and coronal planes significantly improved at 3 months and the last follow-up in both groups com- pared with those preoperatively (P＜0.05) , which in the 3D group were significantly better than those in the conventional group at 3 months and the latest follow-up (P＜0.05) . [Conclusion] The 3D printing assisted osteotomy and instrumented correction of kyphosis secondary to ankylosing spondylitis do significantly improve the accuracy of screw placement, shorten operation time, reduce surgical trauma and improve clinical outcome.

Key words:ankylosing spondylitis; kyphosis; 3D printing; osteotomy; instrument correction