3D打印模型在儿童先天性脊柱侧凸治疗中的应用研究

目的探讨3D打印模型在儿童先天性脊柱侧凸治疗中的应用疗效。方法回顾性分析2015年12月至2016年12月于首都医科大学附属北京儿童医院接受手术治疗的83例先天性脊柱侧凸患儿临床及影像学资料,根据是否使用3D打印模型分为试验组(n=44)和对照组(n=39),比较两组手术时间、术中透视次数、置钉准确性、矫形效果及并发症情况。结果本研究共纳入83例先天性脊柱侧凸患儿,其中男童47例,女童36例,平均手术年龄5.98 (1.5~13)岁。行半椎体切除术40例,Ponte截骨术31例,经椎弓根截骨术8例,全脊椎切除术4例。随访时间24~35个月。试验组患儿手术时间短于对照组(180.92±16.74) min (201.51±27.60) min],差异有统计学意义(t=2.798,P<0.05),试验组术中出血量(340.23±89.52) mL vs.(392.64±100.41) mL]及术中透视次数(4.36±0.89 6.05±1.28)明显少于对照组,差异有统计学意义(P<0.05);试验组置钉准确率高于对照组(93.55%vs 79.91%)(X^2=218.00,P<0.05),平均置钉时间明显短于对照组(4.24±1.05) min vs.(8.35±2.29) min],差异有统计学意义(t=10.71,P<0.05)。两组患儿矫形率无明显差异(t=-1.135,P=0.272)。试验组与对照组患儿术后胸膜损伤、硬膜损伤发生率无明显差异(P>0.05)。结论 3D打印模型能清晰、直观显示先天性脊柱侧凸患儿的脊柱结构及形态,为制定手术计划及手术置钉提供帮助,从而提高置钉准确率,减少术中透视次数,缩短手术时间,减少术中出血量。

Clinical efficacy of three-dimensional model in the surgical treatment of congenital scoliosis in children

Objective To explore the clinical efficacy of three-dimensional(3 D) printed model in the surgical treatment of congenital scoliosis in children.Methods From December 2015 to December 2016,a total of 83 operated children of congenital scoliosis were reviewed.According to whether or not using 3 D model,they were divided into 3 D model usage group(A,n=44) and 3 D model non-usage control group(B,n=39).The operative durations,surgical outcomes and complications between two groups were compared.Results There were 47 boys and 36 girls.The follow-up period was(24-35) months.The operative duration of group A was significantly shorter than that of group B and bleeding volume and intraoperative fluoroscopic frequency were significantly less than those of group B(P<0.05).The accuracy of screw placement in observation group was significantly higher than that in group B and the average screw placement time was significantly shorter than that in group B(P <0.05).During follow-ups,both radiology and computed tomography(CT) showed that the corrective rate had no significant inter-group difference.No such serious complications as vascular and nerve injury occurred in two groups.Incidence of pleural and dural injury had no significant inter-group difference(P>0.05)Conclusion 3 D printed model can distinctly and intuitively delineate the structure and shape of spine in children with congenital scoliosis and provide guidance for surgical planning and screw placement.And it also reduces fluoroscopic frequency and bleeding volume.