摘要
目的 探讨3D打印椎体与纳米羟基磷灰石/聚酰胺66(n-HA/PA66)椎体对颈前路椎体次全切融合术(ACCF)术后颈椎矢状面影响及早期临床疗效.方法 收集2020年6月至2022年1月在郑州大学第一附属医院开展ACCF的患者共56例,其中应用3D打印椎体(3D组)28例,n-HA/PA66椎体(n-HA/PA66组)28例,比较两组患者术前一般资料,术后临床和影像学指标.结果 3D 组术后 3、6、12、18 个月 C2～7 Cobb 高于 n-HA/PA66 组(19.42±3.20 比 17.71±2.50、18.71±3.15 比 17.04±1.94、18.49±3.13 比 16.86±2.17、18.32±2.89 比 16.40±1.48,t=-2.233、-2.385、-2.267、-3.121,P＜0.05),3D 组术后 3、6、12、18 个月 C2～7 SVA 低于 n-HA/PA66 组(14.52±2.45 比 16.88±2.50、14.74±2.21 比 17.30±3.86、14.81±2.28 比 17.38±3.91、15.27±2.23 比 17.84±3.76,t=2.595、3.052、3.004、3.107,P＜0.05),3D 组术后 3、6、12、18 个月T1 倾斜角高于 n-HA/PA66 组(24.11±2.88 比 21.47±2.11、23.15±2.67 比 20.46±2.02、23.23± 2.70 比 20.64±2.08、22.58±2.44 比 20.04±2.02,t=-3.912、-4.257、-4.011、-4.253,P＜0.05),3D 组术后 3 个月融合率高于 n-HA/PA66 组[82.1％(46/56)比 65.5％(36/56),x2=4.004,P＜0.05],3D 组术后 12、18 个月下沉率低于 n-HA/PA66 组[5.4％(3/56)比 21.4％(12/56)、7.1％(4/56)比 25.0％(14/56),x2=6.235、6.619,P＜0.05].结论 3D 打印椎体和 n-HA/PA66椎体应用于ACCF都可取得良好的早期临床效果,但3D打印椎体在椎体融合速度、维持生理曲度和减缓沉降方面更具优势.
Abstract
Objective To compare the cervical sagittal balance and clinical effect between 3D-printed vertebral body and nano hydroxyapatite/polyamide 66(n-HA/PA66)strut after anterior cervical corpectomy and fusion(ACCF).Methods A retrospective analysis was performed on 56 patients who un-derwent ACCF in First Affiliated Hospital of Zhengzhou University from June 2020 to January 2022.Among them,28 patients underwent 3D printed vertebral body fusion(3D group).A total of 28 patients underwent n-HA/PA66 strut fusion(n-HA/PA66 group).Preoperative general data,postoperative clinical and radio-logical parameters of the two groups were analyzed.Results C2-7 Cobb in 3D group was higher than that in n-HA/PA66 group at 3,6,12 and 18 months after surgery(19.42±3.20 vs.17.71±2.50,18.71± 3.15 vs.17.04±1.94,18.49±3.13 vs.16.86±2.17,18.32±2.89 vs.16.40±1.48,t=-2.233,-2.385,-2.267,-3.121,P＜0.05).C2-7SVA in 3D group was lower than that in n-HA/PA66 group at 3,6,12 and 18 months after surgery(14.52±2.45 vs.16.88±2.50,14.74±2.21 vs.17.30±3.86,14.81±2.28 vs.17.38±3.91,15.27±2.23 vs.17.84±3.76,t=2.595,3.052,3.004,3.107,P＜0.05).The inclination of T1 in 3D group was higher than that in n-HA/PA66 group at 3,6,12 and 18 months after surgery(24.11±2.88 vs.21.47±2.11,23.15±2.67 vs.20.46±2.02,23.23±2.70 vs.20.64±2.08,22.58±2.44 vs.20.04±2.02,t=-3.912,-4.257,-4.011,-4.253,P＜0.05).The fusion rate at 3rd month after surgery in the 3D group was higher than that in the n-HA/PA66 group[82.1％(46/56)vs.65.5％(36/56),x2=4.004,P＜0.05].The subsidence rate at 12,18 months after surgery in the 3D group was lower than that in the n-HA/PA66 group[5.4％(3/56)vs.21.4％(12/56),7.1％(4/56)vs.25.0％(14/56),x2=6.235,6.619,P＜0.05].Conclusion Both 3D printed vertebrae and n-HA/PA66 strut can achieve good early clinical results in ACCF,but 3D printed vertebrae have more advantages in interbody fusion speed,maintaining physiological curvature and slowing down settlement.
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