| 摘要: |
| 目的：探究 3-D 打印技术在经皮椎弓根螺钉内固定术治疗中老年单纯性胸腰椎骨折手术中应用的可行性。方法：回顾分析我院 2014 年 1 月—2016 年 6 月收治的中老年胸腰椎爆裂性骨折且符合手术条件的患者 28 例，其中男性 11 例，女性 17 例；年龄 52 ～ 56 岁，平均 56.4 岁。所有患者术前均收集 CT 数据，在 Mimics 软件中进行骨折三维重建，打印出 1:1实体模型，并在 3-D 模型上行模拟手术设计内固定方案，并行经皮椎弓根螺钉内固定术。观察患者围手术期指标 ( 术中失血量、手术时间、引流量、住院时间 ) 、术前术后视觉模拟评分 ( VAS) 、Cobb 角及椎管占位率改变、术后并发症发生情况。结果：手术时间平均 (58.37±10.43) min，术中失血量平均 (51.93±7.65) mL，术后切口引流量平均 (32.41±12.19) mL，住院时间平均 (9.53±2.48) d，所有患者术后随访 14~19 个月，平均 15.7 个月。术前平均 Cobb 角 (16.25±4.29)°，术后2 天 (5.00±1.64) °，术后 12 个月 (5.00±1.55) °。术前平均椎管占位率 (28.18±3.60) %，术后 2 天 (9.71±1.80) %，术后 12 个月 (8.39±1.73) %。Cobb 角及椎管占位率术前术后比较差异有统计学意义 (P<0.05)。术前 VAS (8.07±1.05) 分，术后 1 周 (2.75±0.84) 分，术后 12 个月 (1.50±0.88) 分。术后 VAS 评分较术前显著降低，差异有统计学意义 (P<0.05)。术后 1 周 VAS 评分与术后 12 个月比较差异存在统计学意义（P<0.05）。所有患者均无断钉及内固定物松动、伤椎再骨折、感染、下肢深静脉血栓等并发症。1 例术后 12 个月出现腰背部慢性疼痛，给与口服非甾体类止疼药，症状明显缓解。结论：3-D 打印技术结合经皮椎弓根螺钉内固定术治疗中老年单纯性下胸腰椎骨折可获得满意的早期复位效果，明显改善临床症状，增加伤椎的稳定性，降低并发症发生风险，有很强的临床指导作用。 |
| 关键词: 3D 打印 胸腰椎骨折 椎体成形术 微创 |
| DOI：10.3969/j.issn.1007-6948.2019.06.040 |
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| 基金项目:承德市科技局计划经费项目（201706A040） |
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| Therapeutic Effect of 3-D Printing Combined with Percutaneous pedicle Screw Fixation for Thoracolumbar Burst Fracture |
| MU Huai-zhao,ZHAO Jia-jia,YANG Zhao-xin |
| Department of Trauma and Orthopaedics, Affiliated Hospital of Chengde Medical College, Chengde(067000), Hebei, China |
| Abstract: |
| Objective To investigate the feasibility of 3-D printing technique in the treatment of simple thoracolumbar fractures in middle-aged and elderly patients with percutaneous pedicle screw fixation. Methods A retrospective analysis of 28 patients with thoracolumbar burst fractures from January 2014 to June 2016 in our hospital and meeting the surgical conditions, including 11 males and 17 females, aged 52-65 years, averaged 56. 4 years. CT data were collected before surgery in all patients. Three-dimensional reconstruction of the fracture wasperformed in Mimics software, a 1:1 solid model was printed, and the internal fixation program was designed in 3-D model. The percutaneous pedicle screw fixation was performed. . Perioperative indicators (intraoperative blood loss, operation time, drainage, hospitalization time), preoperative and postoperative visual analogue scale (VAS), Cobb angle and spinal canal occupancy rate, and postoperative complications were observed. Results The average operation time was (58.37±10.43) min, the mean blood loss was (51.93 ± 7.65) mL, the average incision drainage was (32.41±12.19) mL, and the average hospital stay was (9.53±2.48) d. All patients. The patients were followed up for 14 to 19 months with an average of 15.7 months. Preoperative The mean preoperative Cobb angle (16.25±4.29)?, postoperative 2 d (5.00±1.64)?, and postoperative 12 months (5.00±1.55)?. The mean spinal canal occupancy rate was (28.18±3.60)%, 2d (9.71±1.80)% after surgery, and 12 months (8.39±1.73)% after surgery. Cobb angle and spinal canal occupancy rate were statistically significant (P<0.05). VAS (8.07±1.05), 1 week (2.75±0.84), and 12 months (1.50±0.88). The postoperative VAS score was significantly lower than that before surgery (P<0.05).There was a statistically significant difference in VAS score between 1 week after operation and 12 months after operation (P<0.05).All patients had no broken nails and loose internal fixation, fractures of the injured vertebrae, infection, deep vein thrombosis of the lower extremities and other complications. One patient suffered from chronic back pain 12 months after operation. Oral non-steroidal analgesic was given, and the symptoms were obviously relieved.Conclusion 3-D printing combined with percutaneous pedicle screw fixation for the treatment of simple lower thoracolumbar fractures in middle-aged and elderly patients can achieve satisfactory early reduction, significantly improve clinical symptoms, increase the stability of the injured vertebrae, and reduce the risk of complications. , has a strong clinical guiding role. |
| Key words: 3D printing thoracolumbar fracture vertebroplasty minimally invasive |
