3D打印椎间融合器在37例单节段腰椎手术中的应用

目的 探讨3D打印椎间融合器应用于单节段腰椎后路减压植骨融合内固定术后的优势和早期临床疗效。方法 回顾性分析2021年5月至2022年1月于山东第一医科大学附属省立医院脊柱外科行单节段腰椎后路减压植骨融合内固定术患者73例，分为3D打印钛合金椎间融合器(3D cage)组(n=37)和聚醚醚酮椎间融合器(PEEK cage)组(n=36)。分别观察两组患者术前及术后随访的疼痛视觉模拟评分(VAS评分)和Oswestry功能障碍指数(ODI评分),评估腰椎功能及术后改善程度，比较两组患者骨密度(BMD)、手术时间、术中出血量、术中同种异体骨植入量、术后引流量、短期并发症发生情况、腰椎前凸角(LL)、椎间隙高度(DH)、LL丢失值、DH丢失值及椎间融合情况等数据。结果 所有患者均顺利完成手术，术后随访3个月。两组患者手术时间、术中出血量、术后引流量及术后3个月VAS评分和ODI评分比较，差异均无统计学意义(P>0.05);3D cage组同种异体骨植入量少于PEEK cage组，差异有统计学意义(P<0.05);术后两组患者的LL和DH均较术前增大，差异有统计学意义(P<...

Application of 3D-printed titanium interbody fusion cage in 37 cases of single level lumbar surgery

Objective To investigate the advantages and early clinical effects of 3D-printed interbody fusion cage in single level posterior lumbar decompression and bone grafting and internal fixation. Methods Clinical data of 73 patients who underwent single segment posterior lumbar decompression, bone grafting, fusion and internal fixation during May 2021 and Jan. 2022 were retrospectively analyzed. The patients were divided into two groups: 3D-printed titanium cage group(n=37)and poly-ether-ether-ketone(PEEK)cage group(n=36). The visual analogue scale(VAS)and oswestry disability index(ODI)were observed before and after surgery to evaluate the lumbar function and postoperative improvement. The bone mineral density(BMD), operation time, intraoperative bleeding, intraoperative allograft implantation, postoperative drainage, short-term complications, lumbar lordosis(LL), disc height(DH), loss of LL, loss of DH and interbody fusion rate were compared between the two groups. Results All operations were successful and patients were followed up for 3 months. There were no statistical significances between the two groups in operation time, intraoperative bleeding volume, postoperative drainage volume, VAS score and ODI score 3 months after operation(P>0.05). The amount of allogeneic bone implantation in 3D cage group was less than that in PEEK cage group(P<0.05). LL and DH of both groups were significantly larger after operation(P>0.05). There were no significant differences in loss of LL and loss of DH 3 months after surgery between the two groups(P<0.05). However, for patients complicated with osteoporosis, loss of LL and loss of DH in the 3D cage group were smaller than those in the peek cage group(P<0.05). The fusion rate 3 months after surgery was 72.97% in the 3D cage group and 69.44% in the PEEK cage group, with no statistically significant difference(P>0.05). No internal fixation fracture, loosening or displacement occurred. Conclusion The use of 3D-printed interbody fusion cage in single level lumbar fusion has a good effect of vertebral fusion, which can restore and maintain the lumbar lordosis and interbody height. Particularly in patients complicated with osteoporosis, 3D-printed cage has good anti-settlement properties, reduces the risk of vertebral collapse and improves the overall stability of the mechanical structure of the lumbar spine.