3D打印技术辅助成人脊柱侧后凸畸形的术前规划及应用价值
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作者Author单位AddressE-Mail
蒋维利 JIANG Wei-li 蚌埠医学院第二附属医院脊柱外科, 安徽 蚌埠 233040 Department of Spinal Surgery, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233040, Anhui, China  
牛国旗 NIU Guo-qi 蚌埠医学院第二附属医院脊柱外科, 安徽 蚌埠 233040 Department of Spinal Surgery, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233040, Anhui, China ssngq@163.com 
周功 ZHOU Gong 蚌埠医学院第二附属医院脊柱外科, 安徽 蚌埠 233040 Department of Spinal Surgery, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233040, Anhui, China  
陈辉 CHEN Hui 蚌埠医学院第二附属医院脊柱外科, 安徽 蚌埠 233040 Department of Spinal Surgery, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233040, Anhui, China  
刘涛 LIU Tao 蚌埠医学院第二附属医院脊柱外科, 安徽 蚌埠 233040 Department of Spinal Surgery, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233040, Anhui, China  
聂虎 NIE Hu 蚌埠医学院第二附属医院脊柱外科, 安徽 蚌埠 233040 Department of Spinal Surgery, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233040, Anhui, China  
刘路坦 LIU Lu-tan 蚌埠医学院第二附属医院脊柱外科, 安徽 蚌埠 233040 Department of Spinal Surgery, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233040, Anhui, China  
李超 LI Chao 蚌埠医学院第二附属医院脊柱外科, 安徽 蚌埠 233040 Department of Spinal Surgery, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233040, Anhui, China  
周乾坤 ZHOU Qian-kun 蚌埠医学院第二附属医院脊柱外科, 安徽 蚌埠 233040 Department of Spinal Surgery, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233040, Anhui, China  
期刊信息:《中国骨伤》2020年,第33卷,第2期,第99-105页
DOI:10.12200/j.issn.1003-0034.2020.02.002
基金项目:蚌埠医学院自然科学基金面上项目(编号:BYKY18153);蚌埠医学院科研创新团队项目(编号:BYKC201911)
中文摘要:

目的:探讨3D打印技术在成人脊柱侧后凸畸形的术前规划及术中辅助操作的应用价值。

方法:回顾性分析2017年9月至2019年1月收治的12例成人脊柱侧后凸畸形患者,其中男3例,女9例;年龄21~63(47.67±13.32)岁;先天性脊柱侧后凸畸形4例,脊柱陈旧性结核伴后凸畸形2例,特发性脊柱侧后凸畸形2例,退变性脊柱侧后凸畸形4例。将患者脊柱CT断层扫描数据导入Mimics17.0软件中,建立脊柱三维模型,通过3D打印机制作脊柱模型,然后进行术前规划及模拟手术操作,分析其术后影像学参数的改善情况。所有患者随访时间1年以上,于手术前后及末次随访时测量侧凸Cobb角,最大后凸Cobb角,冠状面平衡(distance between C7 plumbline and center sacral vertical line,C7PL-CSVL)和矢状面平衡(sagittal vertical axis,SVA),骨盆参数等相关影像学参数,进一步评估其矫形效果。

结果:12例脊柱侧后凸畸形患者的脊柱矫形术在1:1脊柱模型的指导下,采用不同的截骨矫形内固定融合方式(其中4例畸形较重的患者采用椎弓根螺钉置钉导板辅助椎弓根螺钉置入)置钉及截骨矫形,效果良好,术中、术后无血管、神经、脊髓等重要组织结构损伤,无脑脊液漏、感染等并发症发生。术前侧凸Cobb角为(56.5±22.5)°,后凸Cobb角为(65.2±19.5)°,C7PL-CSVL为(45.8±16.9)mm,SVA为(48.7±25.4)mm。术后4周侧凸Cobb角为(20.8±11.5)°,后凸Cobb角为(22.0±6.6)°,矫正率分别为(65.1±9.7)%和(64.6±10.6)%;C7PL-CSVL为(22.3±8.9)mm,SVA为(23.3±13.1)mm,均较术前明显改善。12例患者均随访1年以上,平均(18.5±7.9)个月,末次随访时侧、后凸Cobb角分别为(22.2±10.8)°和(23.6±7.7)°,C7PL-CSVL为(23.5±10.8)mm,SVA为(24.7±12.5)mm,较术前差异均有统计学意义(P<0.05),末次随访较术后差异无统计学意义(P>0.05)。

结论:3D打印模型可直观清晰地显示成人脊柱侧后凸畸形的椎体形态结构以及其与邻近椎体、血管、神经的空间关系,为手术方案个体化制定提供了良好、直观的立体解剖结构观察。术前预模拟手术操作,确定手术内固定、融合节段及截骨矫形方式,可以为实际临床手术提供参考,并能提高手术的精确性及安全性。
【关键词】3D打印技术  脊柱侧后凸畸形  截骨术
 
3D printing technology assisted the preoperative planning and application value in adult kyphoscoliosis deformity
ABSTRACT  

Objective: To explore the application value of 3D printing technology in preoperative surgery plan and intraoperative auxiliary operation for adult kyphoscoliosis deformity.

Methods: The clinical data of 12 adult patients with kyphoscoliosis deformity treated from September 2017 to January 2019 were retrospectively analyzed. There were 3 males and 9 females,aged from 21 to 63 years old with an average of(47.67±13.32) years old. Among them,4 cases were congenital kyphoscoliosis,2 cases were old tuberculosis thoracolumbar kyphosis;2 cases were idiopathic kyphoscoliosis,4 cases were degenerative kyphoscoliosis. The CT scan data of the patient's spine was imported into Mimics17.0 software to establish the three-dimensional model of the spine,and the spine model was produced by 3D printer. Using the spine model simulated operation,preoperative surgery program planning and formulated a precise surgery,and further analysed postoperative imaging parameters improvement. All the patients were followed up for more than 1 year. Before and after operation and at the last follow-up,the scoliosis Cobb angle,maximum kyphosis Cobb angle,and coronal plane balance (distance between C7 plumbline and center sacral vertical line,C7PL-CSVL),sagittal plane balance(sagittal vertical axis,SVA),pelvic parameters and other related imaging parameters were measured to further evaluate its orthopedic effect.

Results: Twelve patients with spine deformity were treated with different osteotomy and internal fixation fusion methods under the guidance of a 1:1 spine model (pedicle screw placement of 4 patients with severe deformity were assisted by pedicle screw guide plates),nail placement and osteotomy have good effects,no major tissue damage such as blood vessels,nerves and spinal cord during and after surgery,no complications such as cerebrospinal fluid leakage and infection. Preoperative Cobb angle of scoliosis was(56.5±22.5)°,Cobb angle of kyphosis was (65.2±19.5)°,C7PL-CSVL was (45.8±16.9)mm,SVA was(48.7±25.4) mm. Postoperative at 4 weeks,Cobb angle of scoliosis was (20.8±11.5)°,and Cobb angle of kyphosis was (22.0±6.6)°,with correction rates of (65.1±9.7)% and (64.6±10.6)%,respectively;C7PL-CSVL was (22.3±8.9) mm,and SVA was (23.3±13.1) mm,all of which were significantly improved compared with preoperative results. The mean follow-up time was (18.5±7.9) months in 12 patients. At the last follow-up,the Cobb angles of scoliosis and kyphosis were (22.2±10.8)° and(23.6±7.7)°,respectively,C7PL-CSVL was (23.5±10.8) mm,and SVA was(24.7±12.5) mm. The results were statistically significant compared preoperative (P<0.05). There was no significant difference at the postoperative at 4 weeks and the last follow-up(P>0.05).

Conclusion: The 3D print model can visually and clearly show the vertebral morphology and structure of adult kyphoscolisis and its spatial relationship with the adjacent vertebrae,blood vessels,and nerves,which provides a good and intuitive stereoscopic anatomical structure observation for the individualization of the surgical plan. Pre-simulation of operations to determine the internal fixation,fusion segment and osteotomy orthopedic way,may to provide a reference for actual clinical surgery,and can improve the accuracy and safety of surgery.
KEY WORDS  3D printing technology  Kyphoscoliosis deformity  Osteotomy
 
引用本文,请按以下格式著录参考文献:
中文格式:蒋维利,牛国旗,周功,陈辉,刘涛,聂虎,刘路坦,李超,周乾坤.3D打印技术辅助成人脊柱侧后凸畸形的术前规划及应用价值[J].中国骨伤,2020,33(2):99~105
英文格式:JIANG Wei-li,NIU Guo-qi,ZHOU Gong,CHEN Hui,LIU Tao,NIE Hu,LIU Lu-tan,LI Chao,ZHOU Qian-kun.3D printing technology assisted the preoperative planning and application value in adult kyphoscoliosis deformity[J].zhongguo gu shang / China J Orthop Trauma ,2020,33(2):99~105
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