摘要
目的探讨术前3D打印技术与三维CT重建图像在腰椎滑脱症手术中的辅助应用效果。方法选取本院2017年1月~2018年9月收治的腰椎滑脱症患者78例,简单随机化分为两组,均行腰椎椎弓根钉置入术治疗。3D打印组(39例)术前采用3D打印技术制定手术方案,三维CT组(39例)术前采用传统三维CT重建图像制定手术方案。比较两组手术情况、手术前后炎性应激反应[血清肿瘤坏死因子α(TNF-α)、白细胞介素-1α(IL-1α)]水平、腰椎骨性结构参数[骨盆入射角(PI)、骶骨倾斜角(SS)、骨盆倾斜角(PT)、腰椎前凸角(LL)、腰骶角(LSA)、滑脱角(SA)、L 1铅垂线与S 1距离(LASD)]、固定节段矢状曲度恢复率、VAS评分、Oswestry功能障碍指数(ODI)及并发症发生情况。结果3D打印组手术时间、单枚螺钉置入时间均显著短于三维CT组,术中失血量、X线透视次数显著少于三维CT组(P<0.05);3D打印组术后1 d、3 d的血清TNF-α、IL-1α水平显著低于三维CT组(P<0.05);3D打印组术后6、12个月的LL、SA、LASD数值均优于三维CT组(P<0.05);3D打印组术后即刻和术后6、12个月的固定节段矢状曲度恢复率高于三维CT组(P<0.05),术后6个月、12个月VAS评分和ODI指数显著低于三维CT组(P<0.05);3D打印组并发症发生率与三维CT组相比,无显著性差异(P>0.05)。结论与三维CT重建图像相比,术前应用3D打印技术可缩短手术时间、单枚螺钉置入时间,减少术中失血量、X线透视次数,提高术后固定节段矢状曲度恢复率,减轻患者疼痛,改善腰椎骨性结构与功能,并能减轻术后早期的炎症应激反应。
Objective To compare the effect of the preoperative 3D printing technology and the three-dimensional CT reconstructed image in the operation of lumbar spondylolisthesis.Methods Seventy-eight patients with spondylolisthesis treated in our hospital from January 2017 to September 2018 were selected in the research.They were randomly divided into two groups,and all patients were treated with lumbar pedicle screw placement.The 3D printing group(39 cases)used 3D printing technology to make a surgical plan before surgery,and the 3D CT group(39 cases)used traditional 3D CT reconstruction images to make a surgical plan before surgery.The surgical conditions,inflammatory stress response[serum tumor necrosis factorα(TNF-α),interleukin-1α(IL-1α)]levels,lumbar vertebrae structural parameters[pelvic angle of incidence(PI),sacral tilt(SS),pelvic tilt(PT),lumbar lordosis(LL),lumbosacral angle(LSA),slip angle(SA),L 1 plumb line and S 1 distance(LASD)],fixed joint segment sagittal curvature recovery rate,pain visual analogue evaluation(VAS)score,Oswestry dysfunction index(ODI)score and complications were compared between the two groups.Results The operation time and single pedicle screw insertion time in the 3D printing group were shorter than those in the 3D CT group,and the blood loss and X-ray fluoroscopy during the operation were less than those in the 3D CT group(P<0.05).The serum levels of TNF-αand IL-1αin the 3D printing group were lower than those in the 3D CT group at one day and three days after operation(P<0.05).The LL,SA and LASD of the 3D printing group at six and twelve months after operation were better than those of the 3D CT group(P<0.05).The recovery rate of sagittal curvature of the fixed segment was higher in the 3D printing group at immediately after surgery,six months,and twelve months after surgery compared with that in the 3D CT group(P<0.05).The VAS and ODI scores of the 3D printing group at six and twelve months after operation were lower than those of the 3D CT group(P<0.05).There was no significant difference in the incidence of complications between the 3D printing group and the 3D CT group(P>0.05).Conclusion Compared with three-dimensional CT reconstruction images,the application of 3D printing technology before operation can shorten the operation time,the time of single pedicle screw placement,reduce the amount of blood loss and the number of X-ray fluoroscopy during operation,it can improve the recovery rate of the sagittal curvature of the fixed segment after surgery,reduce the patients’pain,improve the lumbar vertebrae bone structure and function,and reduce the early postoperative inflammatory stress response.
作者
黄海翔
伍绍成
何荣龙
陈大乐
邹信明
HUANG Hai-xiang;WU Shao-cheng;HE Rong-long;CHEN Da-le;ZOU Xin-ming(Department of Spinal Surgery,Traditional Chinese Medicine Hospital of Yangchun,Yangchun,Guangdong 529600,China)
出处
《颈腰痛杂志》
2021年第3期293-297,共5页
The Journal of Cervicodynia and Lumbodynia
基金
宁夏回族自治区自然科学基金(编号:NZ16212)。
关键词
3D打印技术
三维CT重建图像
腰椎滑脱症
炎性应激反应
腰椎骨性结构参数
腰椎功能
3D printing technology
3D CT reconstructed image
lumbar spondylolisthesis
inflammatory stress response
lumbar spine structural parameters
lumbar function
