Xin Xin, Liu Xinxin, Zhu Yanan, Li Jiawei, Yue Chen, Hao Dingjun
Ankang Center Hospital, Department of Orthopaedics, Ankang, Shaanxi Province, P.R. China.
Hong Hui Hospital of Xi'an Jiaotong University, Department of Magnetic Resonance Imaging, Xi'an, Shaanxi Province, P.R. China.
World Neurosurg. 2023 May;173:28-33. doi: 10.1016/j.wneu.2023.02.039. Epub 2023 Feb 11.
This paper reports a new three-dimensional (3D)-printed osteotomy guidance system to assist thoracolumbar kyphosis osteotomy and describe the guide plate design, surgical procedure, and short-term clinical results.
The computer-aided design software reconstructs the 3D model of the spinal deformity region using the computed tomography data of the patient and plans the correction angle according to the deformity. The guide plate design described in previous experimental studies was used and optimized before clinical application. The lamina positioning, lamina osteotomy, and vertebral osteotomy guides were designed, and three 3D guides with different functions were used to assist osteotomy.
Seven patients successfully underwent osteotomy under the guidance of a 3D guide plate. Kyphosis was corrected to different degrees without serious complications. At the last follow-up, the back pain and nerve function of 7 patients were improved to varying degrees and the internal fixation without displacement and fracture.
The preliminary clinical application of the new 3D osteotomy guidance system shows that it provides an effective connection between the guide plates and a clinically operative visual field. The use of a 3D guide plate system for positioning and guidance is helpful to complete preoperative planning of anterior and middle column vertebral body osteotomy. However, the efficacy of this method should be compared to that of the free-hand technique with long-term follow-up.
本文报道一种新型三维（3D）打印截骨导向系统，用于辅助胸腰椎后凸截骨，并描述导向板设计、手术过程及短期临床结果。
利用患者的计算机断层扫描数据，通过计算机辅助设计软件重建脊柱畸形区域的3D模型，并根据畸形情况规划矫正角度。采用先前实验研究中描述的导向板设计，并在临床应用前进行优化。设计了椎板定位、椎板截骨和椎体截骨导向器，使用三种功能不同的3D导向器辅助截骨。
7例患者在3D导向板引导下成功进行了截骨。后凸畸形得到不同程度矫正，无严重并发症。末次随访时，7例患者的背痛和神经功能均有不同程度改善，内固定无移位及断裂。
新型3D截骨导向系统的初步临床应用表明，它在导向板与临床手术视野之间提供了有效的连接。使用3D导向板系统进行定位和引导有助于完成前中柱椎体截骨的术前规划。然而，该方法的疗效应与徒手技术的疗效进行长期随访比较。
