区域锁定型3D打印导航模板结合双向修正方案在胸腰椎骨折辅助置钉中的应用
Reliability of a region-locked 3D-printed template combined with a bi-directional matching scheme to assist screw placement for thoracolumbar fractures
张文玺 1周金华 1朱华 1乔之军 1刘波1
作者信息
- 1. 江苏省溧阳市人民医院骨科,常州 213300
- 折叠
摘要
目的 评价区域锁定型3D打印导航模板结合双向修正方案在胸腰椎骨折辅助置钉中的应用效果.方法 回顾性分析2019年1月至2023年3月江苏省溧阳市人民医院骨科收治的52例胸腰椎骨折患者资料.男29例,女23例;年龄(58.2±13.3)岁.将患者按照置钉方法不同分为导板组(25例,采用区域锁定型3D打印导航模板结合双向修正方案术中辅助椎弓根定位置钉)和徒手组(27例,依据影像资料及C型臂X线机透视徒手置钉).比较两组患者的手术时间、术中透视次数、术中出血量、并发症发生率、置钉准确率,比较两组患者的术前、术后1周、末次随访时疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、伤椎前缘高度比.结果 两组患者术前一般资料比较差异均无统计学意义(P＞0.05),具有可比性.所有患者术后随访(11.2±4.2)个月.两组患者间术中出血量、并发症发生率,术前、术后1周、末次随访时的疼痛VAS、ODI、伤椎前缘高度比比较差异均无统计学意义(P＞0.05).导板组患者的手术时间(80.1±18.5)min显著长于徒手组患者的(69.4±16.6)min,但术中透视次数2(2,3)次显著少于徒手组患者的3(3,4)次,置钉准确率98.4％(127/129)显著高于徒手组患者的91.8％(112/122),差异均有统计学意义(P＜0.05).所有患者术后1周的疼痛VAS、ODI、伤椎前缘高度比均较术前显著改善,且末次随访时以上指标较术后1周显著改善,差异均有统计学意义(P＜0.05).所有患者均未出现脊髓、神经根及血管损伤.结论 区域锁定型3D打印导航模板结合双向修正方案在胸腰椎骨折辅助置钉的置钉准确率和透视次数方面均优于徒手置钉,但手术时间较徒手置钉长,两种方法疗效无明显差异.
Abstract
Objective To evaluate the reliability of a region-locked 3D-printed template combined with a bi-directional matching scheme in assistance of screw placement for thoracolumbar fractures.Methods From January 2019 to March 2023,52 patients with thoracolumbar fracture were treated at Department of Orthope-dics,The People's Hospital of Liyang.They were 29 males and 23 females,with an age of(58.2±13.3)years.They were divided into a template group and a free-hand group according to the different screw place-ments.In the template group of 25 cases,a region-locked 3D-printed template combined with a bi-directional matching scheme was used to assist the pedicle positioning;in the free-hand group of 27 cases,the free hand screw placement was assisted only by image data and C-arm fluoroscopy.The operation time,intraoperative flu-oroscopy frequency,intraoperative blood loss,complications,and placement accuracy were compared between the 2 groups.Visual analogue scale(VAS),Oswestry disability index(ODI),and anterior height ratio of the injured vertebra were compared between preoperation,1 week postoperation,and the final follow-up,as well as between the 2 groups.Results There were no statistically significant differences in the preoperative general data between the 2 groups,showing comparability(P＞0.05).All patients were followed up for(11.2±4.2)months.The differences were not statistically significant between the 2 groups in intraoperative blood loss,rate of complications,VAS or ODI at preoperation,1 week postoperation,or the final follow-up,or in anterior height ratio of the injured vertebra(P＞0.05).In the template group,the operation time[(80.1± 18.5)min]was significantly longer than that in the free-hand group[(69.4±16.6)min],the intraoperative fluoroscopy frequency[2(2,3)times]significantly lower than that in the free-hand group[3(3,4)times],and the placement accuracy[98.4％(127/129)]significantly higher than that in the free-hand group[91.8％(112/122)](all P＜0.05).All patients showed significant improvements in VAS,ODI and anteri-or height ratio of the injured vertebra at postoperative 1 week compared with the preoperative values,and the improvements at the last follow-up were significantly larger than those at postoperative 1 week(P＜0.05).No injury to the spinal cord,nerve root or blood vessel was observed postoperatively.Conclusions In the treatment of thoracolumbar fractures,the screw placement assisted by a region-locked 3D-printed template com-bined with a bi-directional matching scheme is better than free-hand screw placement in terms of improved ac-curacy and reduced fluoroscopy,but the former incurs longer operative exposure than the latter.There is no sig-nificant difference between the 2 methods of screw placement in clinical efficacy.
关键词
外科手术,计算机辅助/骨折固定术,内/脊柱/模板/3D打印Key words
Surgery,computer-assisted/Fracture fixation,internal/Spine/Template/Three-dimensional printing引用本文复制引用
基金项目
常州市卫生健康委重大科技项目(ZD201927)
出版年
2024
NETL
NSTL
万方数据