目的 探讨基于三维重建导板的精准椎弓根螺钉置入技术联合保留棘突的改良后路腰椎椎间融合术（modified posterior lumbar interbody fusion,mPLIF）治疗退行性脊柱畸形的临床价值。方法 前瞻性纳入80例退行性脊柱畸形患者,随机分为导板组（40例,三维重建导板辅助置钉+mPLIF）与常规组（40例,传统透视置钉+开放PLIF）。比较两组手术参数（时间、辐射、出血量）、螺钉置入质量（Lu分级）及术后1年随访的疼痛视觉模拟评分（visual analogue scale,VAS）、功能的Oswestry功能障碍指数（Oswestry disability index,ODI）、日本骨科协会（Japanese Orthopaedic Association,JOA）脊髓功能评分。结果 导板组手术时间、辐射暴露、置钉耗时及出血量均显著低于常规组。导板组螺钉可接受率与精准率显著提高。术后1年,导板组VAS、ODI及JOA评分均优于常规组。在并发症方面,导板组总体发生率与明显低于常规组。结论 与传统透视下开放PLIF手术相比,3D打印个体化导板联合有限减压术方案显著优化手术流程,体现在手术时间、术中出血量及医患双方辐射暴露的显著减少,且提升螺钉置入的精准度与安全性,从而降低术中神经损伤与术后感染等并发症的发生风险。
Abstract
Objective To evaluate the clinical value of three-dimensional (3D) reconstructive guide-assisted accurate pedicle screw placement combined with spinous process-preserving modified posterior lumbar interbody fusion (mPLIF) in degenerative spinal deformity. Methods Eighty patients were prospectively randomized into a guide group (n=40, 3D guide-assisted screw placement + mPLIF) and a conventional group (n=40, fluoroscopy-guided screw placement + open PLIF). Perioperative parameters (operation time, radiation exposure, blood loss), screw placement accuracy (Lu classification), and 1-year outcomes (VAS, ODI, JOA) were compared. Results The guide group showed significantly shorter operation time, fewer radiation exposures, reduced screw placement duration, and lower blood loss. The guide group achieved higher acceptable screw rates and precision . At 1-year follow-up, the guide group demonstrated better pain relief, functional recovery, and neurological improvement. In terms of complications, the overall incidence rate of the guide plate group was significantly lower than that of the conventional group. Conclusion Compared with the traditional open PLIF surgery under fluoroscopy, the 3D printed individualized guide plate combined with limited decompression surgery plan significantly optimizes the surgical process, which is reflected in the significant reduction of operation time, intraoperative blood loss, and radiation exposure for both the doctor and the patient. Moreover, it improves the accuracy and safety of screw placement, thereby reducing the risk of complications such as intraoperative nerve injury and postoperative infection.
关键词
三维打印导板 /
椎弓根螺钉精准置入 /
保留棘突 /
退行性脊柱畸形 /
有限减压
Key words
3D-printed guide /
accurate pedicle screw placement /
spinous process preservation /
degenerative spinal deformity /
limited decompression
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参考文献
[1] 任磊, 沈生军, 郭鑫, 等. 退行性脊柱侧弯单节段椎管狭窄斜外侧椎间融合[J]. 中国矫形外科杂志, 2022, 30(14): 1325-1327.
[2] 王栋梁, 邹国友, 吴亚, 等. 长节段与短节段椎弓钉固定退行性脊柱侧弯的比较[J]. 中国矫形外科杂志, 2021, 29(17): 1563-1567.
[3] 潘承波, 徐淑珍, 孙健, 等. 退行性脊柱侧弯长与短节段固定融合术比较[J]. 中国矫形外科杂志, 2021, 29(23): 2144-2148.
[4] 张心灵, 袁磊, 曾岩, 等. 退变性腰椎侧凸后路长节段固定融合术中大量失血的相关危险因素分析[J]. 中国脊柱脊髓杂志, 2019, 29(5): 414-421.
[5] 陆建强, 张翊, 刘晶. 老年退行性脊柱侧弯患者经脊柱后路矫形内固定植骨融合术中大量失血的危险因素分析[J]. 浙江医学, 2021, 43(13): 1424-1427.
[6] 李卫华, 张晓艺, 姜锋, 等. 退行性脊柱侧弯椎管狭窄的减压融合与单纯减压比较[J]. 中国矫形外科杂志, 2021, 29(7): 591-595.
[7] 田霖, 胡鹏, 宁华秀, 等. 数字3D技术辅助经皮椎间孔镜椎间盘切除术治疗退行性腰椎管狭窄[J]. 中国微创外科杂志, 2022, 22(07): 545-552.
[8] 胡昊, 丰瑞兵, 李朝文, 等. 3D显微镜辅助下微创经椎间孔入路腰椎椎间融合术治疗老年退行性腰椎管狭窄症[J]. 中国骨与关节损伤杂志, 2022, 37(03): 303-305.
[9] 刘权祥, 程维, 郭天明, 等. 斜外侧入路植入3D打印侧路融合器联合后路经皮钉复位固定治疗腰椎滑脱症[J]. 西安交通大学学报 (医学版), 2022, 43(1): 96-104.
[10] 李洪珂, 董胜利, 刘帅, 等. 3D打印导航模板辅助置钉在脊柱侧弯术中的应用价值[J]. 生物医学工程与临床, 2022, 26(3): 300-306.
[11] LU S, ZHANG YZ, WANG Z, et al.Accuracy and efficacy of thoracic pedicle screws in scoliosis with patient-specific drill template[J]. Med Biol Eng Comput, 2012, 50(7): 751-758.
[12] 王志远, 黄伟, 胡广, 等. 3D打印微孔钛合金椎间融合器在腰椎退变性疾病手术中的应用[J]. 临床医学, 2025, 45(9): 1-4.
[13] 陈展鹏, 胡奕山, 刘伟军, 等. 3D打印辅助后路椎弓根钉棒内固定术对胸腰椎骨折的疗效及椎间盘损伤的影响[J]. 颈腰痛杂志, 2025, 46(5): 853-860.
[14] 高飞, 王磊, 刘壮壮, 等. 3D打印个性化导板在DS后路腰椎椎板减压融合内固定术中的疗效[J]. 临床和实验医学杂志, 2025, 24(12): 1269-1272.
[15] 于芳, 赵晓勇, 任原, 等. 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[J]. 天津医药, 2025, 53(07): 730-735.
[16] 胡译丹, 唐六一, 俞阳, 等. 3D打印个体化人工椎体在胸腰椎肿瘤整块切除重建中的应用[J]. 实用医院临床杂志, 2025, 22(3): 53-57.
[17] 苏凯, 管廷进, 张引锋, 等. 3D打印多孔钛合金融合器与聚醚醚酮融合器在后路腰椎间融合术中应用的效果比较[J]. 中国骨与关节损伤杂志, 2025, 40(1): 64-67.
[18] 王宾, 王晓龙, 刘倩, 等. 3D打印导板辅助置钉在强直性脊柱炎合并胸腰椎骨折治疗中的应用[J]. 临床骨科杂志, 2024, 27(6): 769-772.
[19] 王凯, 张翔宇, 吴浩. 3D打印技术在脊柱胸腰椎内固定培训中的应用效果研究[J]. 医学教育管理, 2024, 10(5): 572-576.
[20] 李亮, 赵晶, 黄浩然, 等. 3D打印导板辅助后路腰椎椎板减压植骨融合内固定术治疗退行性脊柱侧弯的临床疗效[J]. 中国骨与关节损伤杂志, 2024, 39(9): 913-918.
[21] 邓哲, 邹明, 张涛, 等. 3D打印技术辅助显微镜下单侧入路双侧减压MIS-TLIF治疗腰椎退行性疾病疗效观察[J]. 中国骨与关节损伤杂志, 2024, 39(1): 80-82.
基金
三门峡市科技计划项目“零切迹椎间融合器内固定ZERO-P系统在颈椎前路手术中的应用效果”（2020040350）
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