Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Gongti South Rd, No. 8, Beijing, 100020, China.
J Orthop Surg Res. 2024 May 4;19(1):278. doi: 10.1186/s13018-024-04712-0.
The surgical treatment of severe and complex adult spinal deformity (ASD) commonly required three-column osteotomy (3-CO), which was technically demanding with high risk of neurological deficit. Personalized three dimensional (3D)-printed guide template based on preoperative planning has been gradually applied in 3-CO procedure. The purpose of this study was to compare the efficacy, safety, and precision of 3D-printed osteotomy guide template and free-hand technique in the treatment of severe and complex ASD patients requiring 3-CO.
This was a single-centre retrospective comparative cohort study of patients with severe and complex ASD (Cobb angle of scoliosis > 80° with flexibility < 25% or focal kyphosis > 90°) who underwent posterior spinal fusion and 3-CO between January 2020 to January 2023, with a minimum 12 months follow-up. Personalized computer-assisted three-dimensional osteotomy simulation was performed for all recruited patients, who were further divided into template and non-template groups based on the application of 3D-printed osteotomy guide template according to the surgical planning. Patients in the two groups were age- and gender- propensity-matched. The radiographic parameters, postoperative neurological deficit, and precision of osteotomy execution were compared between groups.
A total of 40 patients (age 36.53 ± 11.98 years) were retrospectively recruited, with 20 patients in each group. The preoperative focal kyphosis (FK) was 92.72° ± 36.77° in the template group and 93.47° ± 33.91° in the non-template group, with a main curve Cobb angle of 63.35° (15.00°, 92.25°) and 64.00° (20.25°, 99.20°), respectively. Following the correction surgery, there were no significant differences in postoperative FK, postoperative main curve Cobb angle, correction rate of FK (54.20% vs. 51.94%, P = 0.738), and correction rate of main curve Cobb angle (72.41% vs. 61.33%, P = 0.101) between the groups. However, the match ratio of execution to simulation osteotomy angle was significantly greater in the template group than the non-template group (coronal: 89.90% vs. 74.50%, P < 0.001; sagittal: 90.45% vs. 80.35%, P < 0.001). The operating time (ORT) was significantly shorter (359.25 ± 57.79 min vs. 398.90 ± 59.48 min, P = 0.039) and the incidence of postoperative neurological deficit (5.0% vs. 35.0%, P = 0.018) was significantly lower in the template group than the non-template group.
Performing 3-CO with the assistance of personalized 3D-printed guide template could increase the precision of execution, decrease the risk of postoperative neurological deficit, and shorten the ORT in the correction surgery for severe and complex ASD. The personalized osteotomy guide had the advantages of 3D insight of the case-specific anatomy, identification of osteotomy location, and translation of the surgical planning or simulation to the real surgical site.
严重和复杂的成人脊柱畸形（ASD）的手术治疗通常需要三柱截骨术（3-CO），该手术技术要求高，神经损伤风险高。基于术前规划的个性化三维（3D）打印导板已逐渐应用于 3-CO 手术中。本研究旨在比较 3D 打印截骨导板和徒手技术在需要 3-CO 的严重和复杂 ASD 患者治疗中的疗效、安全性和精确性。
这是一项单中心回顾性队列研究，纳入了 2020 年 1 月至 2023 年 1 月期间接受后路脊柱融合和 3-CO 的严重和复杂 ASD（脊柱侧凸 Cobb 角>80°，柔韧性<25%或局灶性后凸>90°）患者，随访时间至少 12 个月。所有入组患者均进行了计算机辅助的三维截骨模拟，根据手术计划，将患者进一步分为模板组和非模板组，根据手术计划应用 3D 打印截骨导板。两组患者的年龄和性别均进行了倾向评分匹配。比较两组患者的影像学参数、术后神经功能缺损和截骨执行精度。
共回顾性纳入 40 例患者（年龄 36.53±11.98 岁），每组 20 例。模板组术前局灶性后凸（FK）为 92.72°±36.77°，非模板组为 93.47°±33.91°，主弯 Cobb 角分别为 63.35°（15.00°，92.25°）和 64.00°（20.25°，99.20°）。矫形手术后，两组间术后 FK、术后主弯 Cobb 角、FK 矫正率（54.20%比 51.94%，P=0.738）和主弯 Cobb 角矫正率（72.41%比 61.33%，P=0.101）无显著差异。然而，模板组截骨角度执行与模拟截骨角度的匹配率明显大于非模板组（冠状面：89.90%比 74.50%，P<0.001；矢状面：90.45%比 80.35%，P<0.001）。模板组的手术时间（ORT）明显更短（359.25±57.79 min 比 398.90±59.48 min，P=0.039），术后神经功能缺损发生率（5.0%比 35.0%，P=0.018）明显更低。
在严重和复杂 ASD 的矫正手术中，使用个性化 3D 打印导板辅助进行 3-CO 可以提高执行精度，降低术后神经功能缺损风险，并缩短手术时间。个性化截骨导板具有病例特定解剖结构的 3D 可视化、截骨位置识别以及手术计划或模拟向实际手术部位转化的优势。
