Wu Chao, Tan Lun, Lin Xu, Hu Haigang
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2015 Nov;29(11):1381-8.
To evaluate the clinical significance of individualized reference model of sagittal curves and navigation templates of pedicle screw by three-dimensional printing technique for thoracolumbar fracture with dislocation.
Between February 2011 and November 2013, 42 patients with thoracolumbar fracture and dislocation undergoing pedicle screw fixation were divided into 2 groups: traditional pedicle screw internal fixation by fluoroscopy assistant was used in 24 cases (control group), and individualized reference model of sagittal curves and navigation templates of pedicle screw were used in 18 cases (trial group). There was no significant difference in gender, age, injury causes, segment, degree of dislocation, and Frankel classification between 2 groups (P > 0.05). The operation time, intraoperative blood loss, perspective times, and dislocation rate, sagittal angle recovery rate at different time were compared. The success rate of pedicle screw insertion, sagittal screw angle, and Frankel classification were compared. The angle between sagittal screws, difference of screw entry point at horizontal position, and difference of screw inclined angle were compared.
The operating time, intraoperative blood loss, and perspective times in trial group were significantly lower than those in control groups (P < 0.05). All the patients were followed up 12-40 months (mean, 22 months). The dislocation rate at immediate after operation and last follow-up were significantly improved when compared with preoperative value in 2 groups (P < 0.05). At immediate after operation and last follow-up, the dislocation rate and sagittal angle recover rate in trial group were significantly better than those in control group (P < 0.05). There were significant differences in the one-time success rate, final success rate of pedicle screw insertion, and saggital screw angle between 2 groups (χ2 = 9.38, P = 0.00; χ2 = 10.95, P = 0.00; χ2 = 13.43, P = 0.00). The angle between sagittal screws, difference of screw entry point at horizontal position, and difference of screw inclined angle in trail group were significantly less than those in control group (P < 0.05). There was significant difference in the Frankel classification between 2 groups at last follow-up (Z = -1.99, P = 0.04).
The application of individualized reference model of sagittal curves and navigation templates of pedicle screw by three-dimensional printing technique for thoracolumbar fracture with dislocation has the advantages of shorter operation time, less intraoperative blood loss, better recovery of thoracolumbar dislocation, and better Frankel classification.
评估三维打印技术构建的矢状面曲线个体化参考模型及椎弓根螺钉导航模板在胸腰椎骨折伴脱位中的临床意义。
2011年2月至2013年11月，42例行椎弓根螺钉内固定的胸腰椎骨折伴脱位患者分为2组：24例采用透视辅助下传统椎弓根螺钉内固定（对照组），18例采用矢状面曲线个体化参考模型及椎弓根螺钉导航模板（试验组）。2组在性别、年龄、损伤原因、节段、脱位程度及Frankel分级方面差异无统计学意义（P>0.05）。比较2组手术时间、术中出血量、透视次数、不同时间的脱位率及矢状角恢复率。比较椎弓根螺钉置入成功率、矢状螺钉角度及Frankel分级。比较矢状螺钉间角度、水平位置螺钉进针点差异及螺钉倾斜角度差异。
试验组手术时间、术中出血量及透视次数显著低于对照组（P<0.05）。所有患者随访12～40个月（平均22个月）。2组术后即刻及末次随访时脱位率较术前均显著改善（P<0.05）。术后即刻及末次随访时，试验组脱位率及矢状角恢复率显著优于对照组（P<0.05）。2组椎弓根螺钉置入一次性成功率、最终成功率及矢状螺钉角度差异有统计学意义（χ2=9.38，P=0.00；χ2=10.95，P=0.00；χ2=13.43，P=0.00）。试验组矢状螺钉间角度、水平位置螺钉进针点差异及螺钉倾斜角度差异显著小于对照组（P<0.05）。末次随访时2组Frankel分级差异有统计学意义（Z=-1.99，P=0.04）。
三维打印技术构建的矢状面曲线个体化参考模型及椎弓根螺钉导航模板应用于胸腰椎骨折伴脱位，具有手术时间短、术中出血少、胸腰椎脱位恢复好及Frankel分级改善明显的优点。
