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

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摘要目的比较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。

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关键词 ： 3D打印技术, 胸腰椎骨折, 椎弓根螺钉置入

Abstract：Objective To compare the effect of 3D printing technique，CT and X-ray assisting pedicle screw placement in the treatment of thoracolumbar fractures. Methods Sixty-six patients with thoracolumbar fractures treated in our hospital were retrospectively analyzed and divided into two groups according to the treatment method.33 patients in the control group were treated with conventional CT and X-ray assisting pedicle screw operation and 33 patients in the observation group were treated with pedicle screw operation assisted with 3D printing.The indicators including operation time，intraoperative X-ray exposure，intraoperative blood loss，intraoperative blood transfusion，nail placement related information including number of staples，accurate nail placement，accuracy of nail placement.consistent screws including sagittal screw implantation angle，difference in screw internal inclination angle，difference in horizontal position of screw insertion point，reduction index of injured vertebrae including front and rear height ratio of injured vertebrae，sagittal kyphosis Cobb angle and complications were compared between the two groups during perioperative period.Results The operation time，intraoperative blood loss，intraoperative X-ray exposure and intraoperative blood transfusion in the observation group were significantly lower than those in control group (P＜0.05).The nail placement accuracy of the observation group was 94.4%，which was significantly higher than that of control group (74.5%) (P＜0.05).Sagittal screw implantation angle，difference in screw internal inclination angle，difference in horizontal position of screw insertion point in the observation group were significantly lower than those in control group (P＜0.05).After treatment，front and back height ratio of injured spine of two groups significantly increased(P＜0.05)，and the sagittal kyphosis Cobb angle of two groups significantly decreased(P＜0.05)；the front and back height ratio of injured spine of the observation groupwas significantly higher than that of the control group at 0.5 and 1 year after treatment (P＜0.05)，and the sagittal kyphosis Cobb angle of injured spine of the observation groupwas significantly lower than thatof the control group (P＜0.05).The complication rate of the observation group was 6.1%，which was lower than that of the control group (12.2%) (P＞0.05).Conclusion Compared with conventional CT and X-ray，3D-print assisted pedicle screw therapy in treatment of thoracolumbar fractures has the advantages of short operative time，less intraoperative blood loss and transfusion，low radiation damage，high accuracy of setting screws，correcting the spine deformity significantly and low complication.

Key words： 3D printing technology thoracolumbar fractures pedicle screw placement

基金资助:2015年承德市科学技术研究与发展计划项目(20157060)

作者简介: 刘正蓬(1983－ )，男，主治医师，承德医学院附属医院骨科，067000。

引用本文:

刘正蓬 1，王雅辉 1，褚立 2，明颖 1，张义龙 1，李哲 1，王建华 1，孙贺 1. 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[J]. 实用骨科杂志, 2018, 24(11): 970-974.
Liu Zhengpeng 1，Wang Yahui 1，Chu Li 2，et al. Clinical Analysis of 3D Printing Technique Assisted Pedicle Screw Placement in the Treatment of Thoracolumbar Fractures. sygkzz, 2018, 24(11): 970-974.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2018/V24/I11/970

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