Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Gongtinanlu 8#, Chaoyang District, Beijing 100020, China.
Department of Orthopedics, Beijing Hospital, Peking University, DongdandahuaLu 1#, Dongcheng District, Beijing 100005, China.
Mediators Inflamm. 2022 Aug 29;2022:8134242. doi: 10.1155/2022/8134242. eCollection 2022.
The study was aimed at investigating the reliability of computer-assisted three-dimensional surgical simulation (CA3DSS) of posterior osteotomies in thoracolumbar kyphosis secondary to ankylosing spondylitis (TLKAS) patients.
Eligible TLKAS patients who underwent posterior correction surgery with posterior osteotomies were consecutively included. Simulated posterior osteotomies were performed in Mimics and 3-Matic Medical software. Coronal and sagittal angle and alignment parameters were measured in preoperative full-length X-ray, preoperative original 3D spine (Pre-OS), simulated 3D spine (SS), and postoperative original 3D spine (Post-OS). Reliability was tested by both intraclass correlation coefficients (ICCs) and Bland-Altman analysis.
A total of 30 TLKAS patients were included. Excellent consistency of radiological parameters was shown between preoperative X-ray and Pre-OS model. In SS and Post-OS models, excellent reliabilities were shown in global kyphosis (ICC 0.832, 95% CI 0.677-0.916), thoracic kyphosis (ICC 0.773, 95% CI 0.577-0.885), and lumbar lordosis (ICC 0.896, 95% CI 0.794-0.949) and good reliabilities were exhibited in the main curve (ICC 0.680, 95% CI 0.428-0.834) and sagittal vertical axis (ICC 0.619, 95% CI 0.338-0.798). ICCs of correction angle achieved by pedicle subtraction osteotomy (PSO) was 0.754 (95% CI 0.487-0.892), and that of posterior column osteotomies (PCO) was 0.703 (95% CI 0.511-0.829). Bland-Altman analysis also showed good agreement for both Cobb angle and distance measurements in Pre-OS and SS models, and good reliabilities were shown in PCO and PSO in real spine and SS models.
CA3DSS can provide an accurate measurement, and it is a reliable and effective method to conduct proper simulation for correction surgery with posterior osteotomies in TLKAS patients. This trial is registered with Chinese Clinical Trial Registry ChiCTR2100053808.
本研究旨在探讨计算机辅助三维手术模拟（CA3DSS）在后凸成形术治疗强直性脊柱炎后胸腰椎角（TLKAS）中的可靠性。
连续纳入接受后路矫正手术并进行后路截骨术的符合条件的 TLKAS 患者。在 Mimics 和 3-Matic Medical 软件中进行模拟后路截骨术。在术前全长 X 线片、术前原始三维脊柱（Pre-OS）、模拟三维脊柱（SS）和术后原始三维脊柱（Post-OS）中测量冠状面和矢状面角度和对线参数。通过组内相关系数（ICC）和 Bland-Altman 分析来测试可靠性。
共纳入 30 例 TLKAS 患者。术前 X 线片与 Pre-OS 模型的影像学参数具有极好的一致性。在 SS 和 Post-OS 模型中，总体后凸角（ICC 0.832，95%置信区间 0.677-0.916）、胸椎后凸角（ICC 0.773，95%置信区间 0.577-0.885）和腰椎前凸角（ICC 0.896，95%置信区间 0.794-0.949）具有极好的可靠性，主曲线（ICC 0.680，95%置信区间 0.428-0.834）和矢状垂直轴（ICC 0.619，95%置信区间 0.338-0.798）的可靠性良好。经椎弓根切除截骨术（PSO）的矫正角度 ICC 为 0.754（95%置信区间 0.487-0.892），后柱截骨术（PCO）的 ICC 为 0.703（95%置信区间 0.511-0.829）。Bland-Altman 分析还显示，Pre-OS 和 SS 模型的 Cobb 角和距离测量均具有良好的一致性，并且在真实脊柱和 SS 模型中，PCO 和 PSO 均具有良好的可靠性。
CA3DSS 可以提供准确的测量，是一种可靠有效的方法，可在后凸成形术治疗 TLKAS 患者的后路截骨术中进行适当的模拟。本试验在中国临床试验注册中心注册，注册号 ChiCTR2100053808。
