椎体成形术联合3D打印个性化椎体支架置入在胸腰椎骨折修复中的应用效果

doi:10.11958/20251037

摘要/Abstract

摘要：

目的探讨椎体成形术（PVP）联合基于3D生物力学建模的个性化椎体支架精准置入在胸腰椎骨折修复中的应用效果。方法 98例胸腰椎骨折患者根据不同手术方式分为常规组（50例）和联合组（48例）。常规组采用PVP治疗，联合组采用PVP联合3D打印个性化椎体支架治疗。记录2组患者术中切口长度、手术时间、出血量、引流量、住院时间。于术前及术后1个月采用Oswestry功能障碍指数（ODI）评估患者胸腰椎功能改善情况，并计算Cobb角、伤椎前缘高度及矢状面指数。于术前及术后1个月采用疼痛视觉模拟量表（VAS）和健康状况调查简表（SF-36）评价患者腰痛和下肢痛情况及生活质量，并记录2组术后并发症发生情况。结果联合组术中切口长度、手术时间、出血量、引流量、住院时间均低于常规组（P<0.05）。2组术后1个月ODI评分及Cobb角均低于术前，且联合组均低于常规组（P<0.05）。术后1个月伤椎前缘高度及矢状面指数均高于术前，且联合组均高于常规组（P<0.05）。2组术后1个月VAS评分均低于术前，且联合组低于常规组；SF-36评分均高于术前，且联合组高于常规组（P<0.05）。联合组并发症发生率低于常规组（2.08% vs. 16.00%，P<0.05）。常规组和联合组的术后总体满意度无明显差异。结论 PVP联合3D打印个性化椎体支架治疗胸腰椎骨折效果显著，患者疼痛和生活质量明显改善，手术安全性较好。

关键词: 骨折, 椎体, 椎体成形术, 生物力学, 3D打印, 骨水泥渗漏

Abstract:

Objective To explore the application effect of vertebroplasty (PVP) combined with precise personalized vertebral stent implantation based on 3D biomechanical modeling in the repair of thoracolumbar fractures. Methods A total of 98 patients with thoracolumbar vertebral fractures treated at our hospital from September 2021 to December 2022 were selected for this study. Patients were divided into two groups based on the surgical method: the conventional group (n=50) and the combined group (n=48). The conventional group received PVP treatment, while the combined group was treated with PVP combined with 3D-printed personalized vertebral body stents. The length of incision, operation time, blood loss, drainage volume and hospital stay of the two groups were recorded. The Oswestry Disability Index (ODI) was used to assess the improvement of thoracolumbar function in patients before surgery and one month after the surgery. Cobb angle, anterior height of injured vertebra and sagittal position index were measured. Visual Analog Scale (VAS) for pain and Short Form-36 (SF-36) questionnaire for quality of life were used to evaluate low back pain, lower extremity pain and quality of life of patients before surgery and one month after surgery. Postoperative complications were also recorded. Results The length of incision, operation time, blood loss, drainage volume and hospital stay were lower in the combination group than those of the conventional group (P<0.05). ODI score and Cobb angle were lower 1 month after surgery than those before surgery in both groups, and the combined group was lower than the conventional group (P<0.05). One month after operation, the anterior height and sagittal position index of injured vertebrae were higher than those before surgery, and the combined group was higher than the conventional group (P<0.05). VAS scores were lower and SF-36 scores were higher in both groups one month after operation compared to those before the operation, with the combined group showing lower VAS scores and higher SF-36 scores compared to the conventional group (P<0.05). The total complication rate was lower in the combined group (2.08%) than that in the conventional group (16.00%, P<0.05). There was no significant difference in the overall postoperative satisfaction between the conventional group and the combined group. Conclusion The treatment of thoracolumbar fractures with PVP combined with 3D printed personalized vertebral stenting has a remarkable effect. The pain and quality of life of patients have been significantly improved, and the surgical safety is relatively good.

Key words: fractures, vertebral body, percutaneous vertebro plasty, biomechanics, 3D printing, cement leakage

中图分类号:

R274.1

图/表 6

参考文献 24

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组别		n	年龄/岁			性别
组别		n	年龄/岁			男		女
常规组		50	52.64±4.62			28（56.0）		22（44.0）
联合组		48	53.04±4.86			30（62.5）		18（37.5）
t或χ²			0.419			0.428
组别	骨折部位
组别	T₁₁			T₁₂	L₁		L₂		L₃
常规组	8（16.0）			10（20.0）	12（24.0）		13（26.0）		7（14.0）
联合组	9（18.7）			8（16.7）	13（27.1）		10（20.8）		8（16.7）
χ²	0.739

组别		n	年龄/岁			性别
组别		n	年龄/岁			男		女
常规组		50	52.64±4.62			28（56.0）		22（44.0）
联合组		48	53.04±4.86			30（62.5）		18（37.5）
t或χ²			0.419			0.428
组别	骨折部位
组别	T₁₁			T₁₂	L₁		L₂		L₃
常规组	8（16.0）			10（20.0）	12（24.0）		13（26.0）		7（14.0）
联合组	9（18.7）			8（16.7）	13（27.1）		10（20.8）		8（16.7）
χ²	0.739

组别	n	切口长度/cm	手术时间/min
常规组	50	11.08±1.25	35.94±4.80
联合组	48	10.46±0.82	30.24±4.35
t		2.879＊	6.142＊＊
组别	术中出血量/mL	术后引流量/mL	住院时间/d
常规组	32.64±3.78	25.30±4.14	5.38±0.88
联合组	26.48±3.06	23.63±3.85	4.46±0.62
t	8.849^＊＊	2.074^＊	6.002^＊＊

组别	n	切口长度/cm	手术时间/min
常规组	50	11.08±1.25	35.94±4.80
联合组	48	10.46±0.82	30.24±4.35
t		2.879＊	6.142＊＊
组别	术中出血量/mL	术后引流量/mL	住院时间/d
常规组	32.64±3.78	25.30±4.14	5.38±0.88
联合组	26.48±3.06	23.63±3.85	4.46±0.62
t	8.849^＊＊	2.074^＊	6.002^＊＊

组别	n		ODI/分
组别	n		术前		术后1个月		t
常规组	50		60.46±9.32		18.36±2.89		28.520^＊＊
联合组	48		61.04±9.31		12.50±1.81		34.501^＊＊
t			0.309		11.969^＊＊
组别		Cobb角/°
组别		术前		术后1个月		t
常规组		17.44±2.48		7.14±0.67		27.548^＊＊
联合组		16.94±2.60		5.48±0.50		29.094^＊＊
t		0.958		13.811^＊＊
组别		伤椎前缘高度/%
组别		术前		术后1个月		t
常规组		66.48±10.21		85.27±10.08		9.086^＊＊
联合组		67.34±9.81		89.55±8.26		12.099^＊＊
t		0.425		2.288^＊
组别		矢状面指数/%
组别		术前		术后1个月		t
常规组		62.54±4.95		79.24±9.30		10.565^＊＊
联合组		62.87±6.06		83.66±9.64		14.139^＊＊
t		0.296		2.312^＊