3D打印个体化人工椎体重建用于脊柱肿瘤术后的临床价值

目的 研究3D打印个体化人工椎体重建用于脊柱肿瘤术后的临床价值。方法选择医院收治的60例脊柱肿瘤患者为研究对象，使用随机数表法将其分为观察组和对照组，各30例。两组均行多节段椎体切除术，观察组采用3D打印人工椎体重建脊柱序列，对照组采用钛网材料重建脊柱序列。比较两组围术期指标，包括切除节段数、术中出血量、手术时间、住院时间、术后7 d视觉模拟评分法（VAS）评分；比较两组不同时点日本骨科协会评估治疗（JOA）评分；分别于术后1周、术后1、3个月测量融合节段椎体前缘高度（HAB）、椎体后缘高度（HPB）、cobb角度，并计算术后1、3个月HAB、HPB、cobb角度下降值；比较两组术后并发症发生情况。结果与对照组相比，观察组术中出血量较低、手术时间较短（P<0.05）；两组切除节段数、住院时间、术后7 d VAS评分差异无统计学意义（P>0.05）；术后1周至术后3个月，两组JOA评分均呈上升趋势（P<0.05）；与对照组相比，观察组术后1周、术后1、2、3个月JOA评分均较高（P<0.05）；与对照组相比，观察组术后1、3个月HAB减小值、HPB减小值、cobb角减小值均较小（P<0.05）；两组术后并发症发生率差异无统计学意义（P>0.05）。结论3D打印个体化人工椎体重建用于脊椎肿瘤切除术，有利于缩短手术时间、减低术中出血量、促进脊柱神经功能恢复、降低内植物沉降速度。

Clinical value of 3D printed personalized artificial vertebral weight construction for spinal tumor surgery

Objective To study the clinical value of 3D printed artificial vertebral weight construction for spinal tumor surgery. Methods A total of 60 patients with spinal tumor were selected, and were divided into observation group and control group by random number table method (n=30). Both groups received multilevel vertebra resection. The observation group used 3D printing artificial vertebral weight to reconstruct the spinal sequence, while titanium mesh material was used in control group. Perioperative indexes, including number of resection segments, intraoperative blood loss, operative time, length of hospital stay, and VAS score 7 days after surgery, were compared between the two groups. The Japanese Orthopaedic Association evaluation treatment (JOA) score was compared between the two groups at different time points. Anterior vertebral height (HAB), posterior vertebral height (HPB) and Cobb Angle of fusion segment were measured 1 week, 1 month and 3 months after surgery, respectively; and the reduced values of HAB, HPB and CoBB Angle were calculated 1 and 3 months after surgery. The incidence of postoperative complications was compared between the two groups. Results Compared with the control group, the observation group had significantly lower intraoperative blood loss and shorter operation time (P<0.05). There was no significant differences in the number of resection segments, length of hospital stay or 7 days VAS score between the two groups (P>0.05). From 1 week to 3 months after surgery, JOA scores in both groups showed significantly upward trends (P<0.05). Compared with the control group, the observation group had significantly higher JOA scores 1 week, 1 month, 2 months and 3 months after surgery (P<0.05). Compared with the control group, the reduced values of HAB, HPB and COBB Angle in observation group were significantly smaller 1 month and 3 months after surgery (P<0.05). There was no significant difference in postoperative complication rate between the two groups (P>0.05). Conclusion 3D printing of personalized artificial vertebral body weight for spinal tumor resection is beneficial to shorten the operation time, reduce the amount of blood loss, promote the recovery of spinal nerve function, and reduce the rate of plant deposition.