| 白马恒,高 东,李耀章,张 伟,李卫勤,杨智泉.3D数字打印技术在重度脊柱侧弯中的临床分析研究[J].,2020,(4):722-726 |
| 3D数字打印技术在重度脊柱侧弯中的临床分析研究 |
| Clinical Efficacy of 3D Printing and Digital Technique in the Treatment of Severe Congenital Scoliosis |
| 投稿时间：2019-09-23 修订日期：2019-10-18 |
| DOI：10.13241/j.cnki.pmb.2020.04.026 |
| 中文关键词: 脊柱侧弯 置钉准确率 3D打印 |
| 英文关键词: Congenital scoliosis Placement accuracy 3D printing |
| 基金项目:国家自然科学基金项目（81372045） |
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| 中文摘要: |
| 摘要 目的：评估和比较3D数字打印技术在重度脊柱侧弯患者手术中的临床疗效及安全性。方法：按照已经设定的纳入及排除标准，对2017年1月至2019年1月诊断为重度脊柱侧弯并在我科行手术治疗的22名患者进行前瞻性分析。根据是否采用3D打印技术辅助，将其通过随机数字表分为3D辅助组（实验组）与对照组。实验组（共11例）通过Minics软件进行3D模拟设计及打印，术中进行技术辅助。对照组（11例）则通过常规的徒手置钉办法进行手术。通过CT比较两组患者的置钉准确性，并比较两组患者的其他影像学检查和相关手术指标,包括：手术时间，输血量，透视次数等。结果：本研究纳入的患者（22例）均得到至少6个月的完整随访。两组患者在术前的影像学测评，Cobb角，年龄、性别构成等指标的比较中未见显著统计学差异(P>0.05)。实验组CT评价置钉准确率为83.6%（0级及1级），对照组的置钉准确率为72.3%。两组比较有统计学差异(P<0.05)。实验组在手术时间，术中输血量及透视次数等手术指标的比较中均显著优于对照组(P<0.05)。实验组的入院后待手术时间显著高于对照组(P<0.05)。实验组在术后3天的VAS指标显著优于对照组(P<0.05)，但在术后6月的比较中无显著性差异(P>0.05)。两组患者的ODI指数较术前均有显著改善(P<0.05)，且两组间无显著性差异(P>0.05)。两组患者均未出现严重并发症(P>0.05)。结论：与常规的徒手置钉相比，针对重度脊柱侧弯患者，3D数字打印辅助技术能够显著的提高置钉的准确性，减少手术时间和术中输血量，大幅度减少透视危害，且降低操作难度，值得临床进一步推广使用。 |
| 英文摘要: |
| ABSTRACT Objective: To evaluate the clinical outcome of 3D print and digital technique in the treatment of severe congenital scoliosis. Methods: From 2017.01 to 2019.01，22 cases of severe congenital scoliosis were divided into two groups according to random numbers method. 11 patients underwent surgery using a novel 3D print and digital technique (experimental group), while 11 patients underwent surgery by the free hand technology method (control group). The clinical outcomes were evaluated by the accuracy of pedicle screw placement of CT examination and operation time, fluoroscopic frequency and the cement amount in surgery. Results: All the patients (22 patients) underwent successful 6 months completed follow-up. There was no significant difference between 2 groups on Cobb, age, imaging and sex(P>0.05). Postoperative CT was used to evaluate the pedicle screw placement accuracy, experimental group placement accuracy (grade 0 and 1) was 83.6%, significantly higher than the 72.3% of the conventional group(P<0.05). The operative time, radioactive frequency and intraoperative blood transfusion were all lower in the experimental group than in the conventional group; The preoperative waiting time(P<0.05) were more than the control group. The VAS and ODI score of two groups were significant decreased after operation. There was significant difference between 2 groups on 3th day post-operation(P<0.05). There was no statistical significance at 6 month postoperative(P>0.05). The ODI index at 6 months postoperative was no statistically significant(P<0.05). There was no significant difference in postoperative imaging parameters and the incidence of screw-related complications between the two groups. Conclusion: Comparing the conventional method, using the 3D printing and digital can significantly shorten the the difficult and high risk of screw implanting, reduce the intaoperative radioactive frequency and be easy to understand, which could be further promoted in clinic. |
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