摘要
目的 探讨3D打印联合"O"型臂(O-arm)导航辅助后路半椎体切除治疗先天性颈胸段侧凸畸形的临床疗效.方法 回顾性分析2015年1月至2021年6月河南省人民医院收治的半椎体畸形致先天性颈胸段侧凸患儿14例,男9例、女5例,年龄(8.9±3.2)岁(范围1～15岁).记录手术时间、术中出血量及融合节段.术中行O-arm扫描、术后行CT扫描评估置钉准确率.分析术前、模型设计、术后1周及末次随访时影像学测量颈胸段侧凸Cobb角、代偿性侧凸Cobb角、局部后凸Cobb角、颈椎倾斜角、T1倾斜角及锁骨角,评估手术设计、术中矫形及随访丢失情况.采用脊柱侧凸研究学会-22简明量表调查问卷(Scoliosis Research Society question naires-22,SRS-22)评估功能及临床疗效.末次随访时采用Eck融合分级标准评价植骨融合情况.结果 14例患儿均顺利完成手术,手术时间(228.5±41.8)min,术中出血量(355.6±46.7)ml,融合节段为(5.5±0.8)个,随访(35.5±13.2)个月.共置入140枚椎弓根螺钉,置钉准确率97.1％(136/140).颈胸段侧凸Cobb角术前为53.9°±17.9°、模型设计为11.3°±4.4°、术后1周为10.8°±2.6°、末次随访为14.5°±3.5°,差异有统计学意义(P＜0.001),术后1周与术前的差异有统计学意义(P＜0.001),术后矫形率为78.6％±6.7％.代偿性侧凸Cobb角术前为33.1 °± 12.1°、模型设计为11.9°±2.4°、术后1周为10.5°±3.4°、末次随访为14.1°±2.5°,差异有统计学意义(P＜0.001),术后1周与术前的差异有统计学意义(P＜0.001),术后矫形率为65.2％±16.2％.局部后凸Cobb角术前为27.8°±9.8°、模型设计为10.1°± 2.1°、术后1周为9.8°±1.9°、末次随访为12.7°±1.6°,差异有统计学意义(P＜0.001),术后1周与术前的差异有统计学意义(P＜0.001),术后矫形率为59.2％±18.9％.颈椎倾斜角术前为20.6°±6.7°、模型设计为6.2°±1.9°、术后1周为5.9°±2.1°、末次随访为7.1°±1.4°,差异有统计学意义(P＜0.001),术后1周与术前的差异有统计学意义(P＜0.001),术后矫形率为70.0％± 11.1％.T1倾斜角术前为20.2°±5.8°、模型设计为11.5°±3.1 °、术后1周为10.2°±2.3°、末次随访为9.5°±3.0°,差异有统计学意义(P＜0.001),术后1周与术前的差异有统计学意义(P＜0.001),术后矫形率为53.2％±10.4％.术前设计的矫形指标与术后1周实际测量值的差异均无统计学意义(P＞0.05).末次随访时SRS-22量表中自我形象(4.6±0.7)分、心理健康(4.7±0.6)分、治疗满意度(4.6±0.6)分,均较术前改善(P＜0.05).1例患儿术后出现半椎体同侧C8神经根损伤症状,予以脱水、激素及营养神经药物等保守治疗,术后3个月恢复正常.末次随访时所有患儿头颈肩部外观较术前改善,植骨均达骨性融合,Eck融合分级均为Ⅰ级.围手术期均未出现严重神经或血管损伤,随访过程中均未发生假关节形成、内固定松动或断裂.结论 3D打印联合O-arm导航辅助后路半椎体切除治疗先天性颈胸段侧凸畸形,可预先、立体及实时显示畸形结构,准确置入椎弓根螺钉并完整切除半椎体,提高手术安全性及畸形矫正率.
Abstract
Objective To investigate the clinical effect of 3D printing combined with O-arm navigation assisted posterior hemivertebrae resection and orthopedic fixation in the treatment of congenital cervicothoracic scoliosis.Methods A retrospec-tive study was conducted on the clinical data of 14 patients with congenital cervicothoracic kyphosis caused by hemivertebra treat-ed in Henan Provincial People's Hospital from January 2015 to June 2021,including 9 males and 5 females,aged 8.9±3.2 years(range,1-15 years).Operation time,intraoperative blood loss and fusion stage were recorded.Intraoperative O-arm scanning and postoperative CT scanning were performed to evaluate the accuracy of nail placement.The cervicothoracic scoliosis Cobb angle,compensatory scoliosis Cobb angle,local kyphosis Cobb angle,torticollis angle,T,tilt angle and clavicular angle were measured before operation,model design,1 week after operation and at the last follow-up to evaluate the effect of surgical design,intraopera-tive orthosis and the correction loss at follow-up.The Society for Scoliosis Research-22(SRS-22)questionnaire was used to evalu-ate the functional and treatment effect.At the last follow-up,the osteotomy fusion was evaluated by Eck criterion.Results All pa-tients successfully completed the operation,the operation time was 228.5±41.8 min,the intraoperative blood loss was 355.6±46.7 ml,and the number of fusion segments was 5.5±0.8.Follow-up duration was 35.5±13.2 months.A total of 140 pedicle screws were inserted,with an accuracy of 97.1％(136/140).The Cobb angle of cervicothoracic scoliosis was 53.9°±17.9° preoperatively,11.3°± 4.4° in the model design,10.8°±2.6° one week postoperatively,and 14.5°±3.5° at the last follow-up,with statistical significance(P＜0.001).The preoperative and postoperative one week difference was statistically significant(P＜0.001)with a correction rate of 78.6％±6.7％.The Cobb angle of compensatory scoliosis was 33.1°±12.1° before surgery,11.9°±2.4° for model design,10.5°±3.4° for one week after surgery,and 14.1°±2.5° for the last follow-up,with statistically significant differences(P＜0.001).The postopera-tive correction rate was 65.2％±16.2％.The Cobb angle of local kyphosis was 27.8°±9.8° preoperatively,10.1°±2.1° in the model design,9.8°±1.9° one week postoperatively,and 12.7°±1.6° at the last follow-up,with statistical significance(P＜0.001).The pre-operative and postoperative one week difference was statistically significant(P＜0.001)with a correction rate of 59.2％±18.9％.The preoperative and postoperative one week difference was statistically significant(P＜0.001)with a correction rate of 78.6％±6.7％.The neck tilt angle was 20.6°±6.7° preoperatively,6.2°±1.9° in the model design,5.9°±2.1° one week postoperatively,and 7.1°± 1.4° at the last follow-up,with statistical significance(P＜0.001).The preoperative and postoperative one week difference was sta-tistically significant(P＜0.001)with a correction rate of 70.0％±11.1％.The T,inclination angle was 20.2°±5.8° preoperatively,11.5°±3.1° in the model design,10.2°±2.3° one week postoperatively,and 9.5°±3.0° at the last follow-up,with statistical signifi-cance(P＜0.001).The preoperative and postoperative one week difference was statistically significant(P＜0.001)with a correction rate of 53.2％±10.4％.There was no significant difference between preoperative design and actual measurement one week after sur-gery(P＞0.05).At the last follow-up,the scores of self-image(4.6±0.7),mental health(4.7±0.6)and treatment satisfaction(4.6±0.6)in SRS-22 scale were significantly improved compared with those before operation(P＜0.05).The symptoms of hemivertebra ipilat-eral C8 nerve root injury occurred in 1 patient,who was treated conservatively with dehydration,hormones and nutraceutical drugs,and recovered to normal at 3 months follow-up.At the last follow-up,the appearance of the head,neck and shoulders of the pa-tients was improved compared with that before surgery,the bone grafts have achieved osseous fusion in all patients.All fusion were grade I by Eck criterion.No complications such as serious neurological or vascular injury occurred during perioperative peri-od.No pseudoarthrosis formation,internal fixation loosening or fracture occurred during follow-up.Conclusion The application of 3D printing combined with O-arm navigation assistance technology in posterior hemivertebra resection and correctional surgery for cervicothoracic hemivertebra deformities can display the deformities in advance,stereoscopic and real-time,accurately place pedicle screws and complete hemivertebra resection,improve surgical safety and deformity correction rate.
基金项目
河南省医学科技攻关计划联合共建项目(LHGJ20220036)
河南省科技攻关计划(242102310077)
NETL
NSTL
万方数据