3D打印个体化人工椎体在胸腰椎肿瘤整块切除后脊柱稳定性重建中的应用

目的探索3D打印个体化人工椎体在胸腰椎肿瘤整块切除后脊柱稳定性重建中的临床疗效。方法回顾性分析华中科技大学同济医学院附属同济医院2015年7月至2020年6月收治的接受一期后路全脊椎整块切除术的胸腰椎肿瘤患者28例,分为2组,每组14例。其中3D组使用3D打印个体化人工椎体重建,常规组使用钛笼重建。对比两组的住院时间、手术时间、术中出血量,记录术前、术后7 d及末次随访时视觉模拟评分(VAS),Frankel分级情况,测量节段高度及角度,评估临床疗效。结果两组患者住院时间、手术时间、术中出血量和VAS评分比较,差异无统计学意义。共8例患者Frankel评分获得一个等级的改善(28.6%)。3D组椎间高度丢失(1.9±2.2)mm,内植物沉降2例,沉降率14.3%;常规组椎间高度丢失(6.6±5.5)mm,内植物沉降8例,沉降率57.1%;两组比较差异有统计学意义(<0.05)。在节段角度丢失方面组间差异无统计学意义(=0.571)。3D组所有患者内固定良好,常规组1例患者发生断棒情况。结论 3D打印人工椎体可以更好地维持节段高度,降低椎间隙塌陷和内固定失败的风险。

Application of 3D-printed individual artificial vertebral body in reconstruction of thoracolumbar tumor after total en-bloc spondylectomy

Objective To explore the clinical effect of the reconstruction of thoracic and lumbar spine using the 3D-printed individual artificial vertebral body after total en-bloc spondylectomy. Methods A retrospective analysis was performed on the cases with thoracic and lumbar tumors admitted between July 2015 and June 2020 in Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, twenty-eight patients were divided into two groups (n=14, per group) and underwent total en-bloc spondylectomy by one-stage posterior approach. In the 3D group, 3D-printed individual artificial vertebral body was used for reconstruction, while in the conventional group, it was titanium mesh cage. The length of hospital stay, operation time and blood loss were compared. Visual analogue scale (VAS) and Frankel grading were recorded before operation, 7 days after operation and at the last follow-up, the height and angle of the segments were measured to evaluate the clinical efficacy. Results There were no statistically significant differences in hospital stay, operation time, blood loss and VAS score between the two groups. A total of 8 patients achieved improvement of a grade in Frankel scores (28.6%). In the 3D group, the lost of intervertebral height was (1.9±2.2) mm, and 2 implant subsidence cases with a subsidence rate of 14.3%. Compared with the conventional group, the lost of intervertebral height was (6.6±5.5) mm, and 8 implant subsidence cases with a subsidence rate of 57.1%, which was significantly different (P<0.05). There was no significant difference in segment angle loss between groups (P=0.571). All patients in the 3D group had good internal fixation, while one patient in the conventional group had broken rods. Conclusion The 3D-printed artificial vertebral body can better maintain segment height and reduce the risk of implant subsidence and internal fixation failure.