3D个体化打印导向器在强直性脊柱炎胸腰椎骨折中的应用

Personalized 3D-printed guides for the management of thoracolumbar fractures in ankylosing spondylitis

摘要:

目的 评估3D个体化打印椎弓根螺钉导向置入在强直性脊柱炎患者胸腰椎骨折中的应用效果。方法 回顾性选取2019年1月—2022年10月在西南医科大学附属医院治疗的104例强直性脊柱炎合并胸腰椎骨折患者的临床资料。根据不同置钉方式分为观察组和对照组，分别有53、51例。观察组进行3D打印椎弓根导板辅助置钉；对照组采用传统X射线辅助徒手置钉。比较两组患者围手术期指标、术后1 d的应激指标［血清促肾上腺皮质激素（ACTH）、皮质醇（Cor）］，并对比术前和术后12个月的视觉模拟评分法（VAS）、日本骨科协会腰椎功能评分（JOA）、骨代谢指标［骨钙素、骨碱性磷酸酶（BALP）］、脊柱三维运动范围、伤椎Cobb角、伤椎前缘高度和后缘高度。结果 观察组手术时间、置钉时间、切口长度短于对照组（P <0.05），术中出血量低于对照组（P <0.05），螺钉调整次数少于对照组（P <0.05）。观察组术后1 d ACTH、Cor水平均低于对照组（P <0.05）。观察组手术前后ACTH、Cor的差值均低于观察组（P <0.05）。观察组术后12个月VAS评分均低于对照组（P <0.05），JOA评分、骨钙素、BALP均高于对照组（P <0.05）。观察组患者手术前后VAS评分、JOA评分、骨钙素、BALP的差值均高于观察组（P <0.05）。观察组术后12个月脊柱前屈、后伸、侧屈和旋转范围均大于对照组（P <0.05）。观察组手术前后脊柱前屈、后伸、侧屈和旋转范围的差值均高于观察组（P <0.05）。观察组术后12个月的伤椎前缘高度、后缘高度均高于对照组（P <0.05），伤椎Cobb角低于对照组（P <0.05）。观察组手术前后伤椎Cobb角、伤椎前缘高度和后缘高度的差值均高于观察组（P <0.05）。结论 3D个体化打印导向器引导的椎弓根置入有助于强直性脊柱炎患者胸腰椎骨折后的恢复。

Abstract:

Objective To evaluate the effectiveness of personalized 3D-printed pedicle screw guides in the treatment of thoracolumbar fractures in patients with ankylosing spondylitis.Methods The clinical data of 104 patients with ankylosing spondylitis complicated by thoracolumbar fractures treated at the Affiliated Hospital of Southwest Medical University from January 2019 to October 2022 were retrospectively collected. Based on different pedicle screw placement methods, the patients were divided into an observation group and a control group, with 53 and 51 cases in each group, respectively. The observation group received pedicle screw placement assisted by personalized 3D-printed guides, while the control group underwent conventional pedicle screw placement guided by X-ray imaging. Perioperative indicators and stress indicators 1 day postoperatively [serum adrenocorticotropic hormone (ACTH), cortisol (Cor) ], along with pain scores, Japanese Orthopaedic Association (JOA) lumbar function scores, bone metabolism markers [osteocalcin, bone-specific alkaline phosphatase (BALP) ], spinal three-dimensional range of motion, Cobb angle of the injured vertebra, and anterior and posterior heights of the injured vertebra before and 12 months after surgery, were compared between the two groups.Results Compared with the control group, the observation group had shorter operative duration, screw placement time, and incision length (P < 0.05), lower intraoperative blood loss (P < 0.05), and fewer screw adjustments (P < 0.05). On postoperative day 1, ACTH and Cor levels were lower in the observation group than in the control group (P < 0.05), and the pre- to post-operative changes in ACTH and Cor were smaller in the observation group (P < 0.05). At 12 months postoperatively, the observation group exhibited lower VAS scores and higher JOA scores as well as osteocalcin and BALP levels compared with the control group (P < 0.05). The pre- to post-operative changes in VAS and JOA scores and osteocalcin and BALP levels were greater in the observation group than in the control group (P < 0.05). The spinal range of motion, including flexion, extension, lateral bending, and rotation at 12 months postoperatively, was greater in the observation group than in the control group (P < 0.05), and the corresponding pre- to post-operative changes were also larger in the observation group (P < 0.05). At 12 months postoperatively, the injured vertebra’s anterior and posterior heights were higher and the Cobb angle was lower in the observation group compared with the control group (P < 0.05). Similarly, the pre- to post-operative changes in Cobb angle, anterior height, and posterior height of the injured vertebra were greater in the observation group than in the control group (P < 0.05).Conclusion The use of personalized 3D-printed guides for pedicle screw placement facilitates the recovery of patients with ankylosing spondylitis after thoracolumbar fractures.