打印模型结合多媒体技术后路复位固定椎体间植骨融合治疗C型胸腰椎骨折的效果

Effect of 3D-printed models combined with multimedia technology-assisted posterior reduction, fixation, and intervertebral bone graft fusion in C-type thoracolumbar fractures

摘要:

目的 探讨打印模型结合多媒体技术后路复位固定椎体间植骨融合治疗C型胸腰椎骨折的效果。方法 回顾性分析2023年1月—2024年12月衡水市人民医院骨科收治的80例C型胸腰椎骨折患者的临床资料，按照不同的手术方法将患者分为对照组（38例，后路复位固定椎体间植骨融合）和观察组（42例，打印模型结合多媒体技术后路复位固定椎体间植骨融合）。观察两组螺钉植入情况（螺钉数、植入每颗螺钉的时间、平均出血量及透视次数）、螺钉角度（内倾角、头倾角偏差值）、椎体滑脱率、一次性植钉成功率、并发症发生率，以及术前、术后3个月的伤椎高度恢复比、Cobb角、日本骨科协会评估治疗分数（JOA）、功能障碍指数问卷表（ODI）评分。结果 观察组置入每颗螺钉的时间短于对照组（P 0.05），平均出血量低于对照组（P 0.05），透视次数少于对照组（P 0.05）。观察组内倾角、头倾角偏差值均小于对照组（P 0.05）。观察组椎体滑脱率低于对照组（P 0.05）。观察组一次性植钉成功率高于对照组（P 0.05）。观察组术后3个月伤椎高度恢复比、JOA评分均高于对照组（P 0.05），Cobb角、ODI评分均低于对照组（P 0.05）。观察组术前与术后3个月伤椎高度恢复比、Cobb角、JOA评分的差值均大于对照组（P 0.05）。对照组并发症总发生率高于观察组（P 0.05）。结论 打印模型结合多媒体技术在辅助后路复位固定椎体间植骨融合术效果显著，可缩短置入每颗螺钉的时间、内倾角及头倾角偏差值，降低平均出血量、透视次数、椎体滑脱率、并发症发生率，提高一次性植钉成功率，有利于伤椎高度恢复，促进功能的恢复。

Abstract:

Objective To investigate the effect of 3D-printed models combined with multimedia technology in assisting posterior reduction, fixation, and intervertebral bone graft fusion for the treatment of C-type thoracolumbar fractures.Methods A retrospective analysis was conducted on the clinical data of 80 patients with C-type thoracolumbar fractures treated in the Department of Orthopedics at Hengshui People's Hospital between January 2023 and December 2024. According to different surgical methods, patients were divided into a control group (n = 38), who underwent posterior reduction, fixation, and intervertebral bone graft fusion, and an observation group (n = 42), who underwent surgery assisted by 3D-printed models combined with multimedia technology. The screw implantation conditions (number of screws, time per screw placement, intraoperative blood loss, and fluoroscopy frequency), screw placement accuracy (deviation of medial inclination angle and cephalad inclination angle), vertebral slippage rate, one-time screw placement success rate, complication rate, and preoperative and 3-month postoperative outcomes including injured vertebral height restoration ratio, Cobb angle, Japanese Orthopaedic Association (JOA) scores, and Oswestry Disability Index (ODI) scores were compared between the two groups.Results The time required for placement of each screw in the observation group was significantly shorter than that in the control group (P 0.05). Intraoperative blood loss and fluoroscopy frequency were also significantly lower in the observation group (P 0.05). The deviations of medial inclination angle and cephalad inclination angle were smaller in the observation group than in the control group (P 0.05). The vertebral slippage rate was lower, while the one-time screw placement success rate was higher in the observation group (P 0.05). At 3 months postoperatively, the observation group showed a higher injured vertebral height restoration ratio and JOA scores, and lower Cobb angle and ODI scores compared with the control group (P 0.05). The improvements in the injured vertebral height restoration ratio, Cobb angle, and JOA scores from preoperative to postoperative values were also greater in the observation group (P 0.05). The overall complication rate was significantly higher in the control group than in the observation group (P 0.05).Conclusion The application of 3D-printed models combined with multimedia technology in assisting posterior reduction, fixation, and intervertebral bone graft fusion demonstrates significant clinical benefits. It can shorten the time required for screw placement, improve screw placement accuracy, reduce intraoperative blood loss, fluoroscopy frequency, vertebral slippage rate, and complication rate, and increase the success rate of one-time screw placement. Moreover, it facilitates the restoration of the injured vertebral height and promotes functional recovery.