Bai Yunsong,Zhang Xuejun,Cao Jun,et al.Clinical efficacy of three-dimensional model in the surgical treatment of congenital scoliosis in children[J].Journal of Clinical Pediatric Surgery,2020,19(02):115-119.[doi:10.3969/j.issn.1671-6353.2020.02.005]
3D打印模型在儿童先天性脊柱侧凸治疗中的应用研究
- Title:
- Clinical efficacy of three-dimensional model in the surgical treatment of congenital scoliosis in children
- Keywords:
- 3D Printed Model; Scoliosis/CN; Osteotomy; Treatment Outcome; Complications; Child
- 分类号:
- R726.8;R682.3;R44
- 摘要:
- 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6.15（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 vs.（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 vs. 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%）（χ2=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。
- Abstract:
- Objective To explore the clinical efficacy of three-dimensional (3D) 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 3D model,they were divided into 3D model usage group (A,n=44) and 3D 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 3D 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.
参考文献/References:
1 Puvanesarajah V,Shen FH,Cancienne JM,et al.Risk factors for revision surgery following primary adult spinal deformity surgery in patients 65 years and older[J].J Neurosurg Spine,2016,25(4):486-493.DOI:10.3171/2016.2.spine151345.
2 郝申申,刘志斌,王飞,等.3D打印导航模板在脊柱侧凸矫形术中的初步应用[J].临床误诊误治,2018,31(6):56-59.DOI:10.3969/j.issn.1002-3429.2018.06.019. Hao SS,Liu ZB,Wang F,et al.Preliminary application of 3D printing navigation template in scoliosis orthopedics[J].Clinical Misdiagnosis & Mistreatment,2018,31(6):56-59.DOI:10.3969/j.issn.1002-3429.2018.06.019.
3 蔡文全,姚瑞翔,宿玉玺,等.3D打印技术在儿童先天性脊柱半椎体手术治疗中的应用研究[J].临床小儿外科杂志,2018,17(4):259-262.DOI:10.3969/j.issn.1671-6353.2018.04.005. Cai WQ,Yao RX,Su YX,et al.Application of three-dimensional printing for congenital hemivertebra[J].J Clin Ped Sur,2018,17(4):259-262.DOI:10.3969/j.issn.1671-6353.2018.04.005.
4 Cavanaugh PK,Mounts T,Vaccaro AR.Use of 3-Dimensional printing in spine care[J].Contemp Spine Surg,2015,16(1):1-6.DOI:10.1097/01.CSS.0000459537.10289.af.
5 Malik HH,Darwood ARJ,Shaunak S,et al.Three-dimensional printing in surgery:a review of current surgical applications[J].J Surg Res,2015,199(2):512-522.DOI:10.1016/j.jss.2015.06.051.
6 李彦明,李明,张国友,等.3D打印在脊柱侧凸矫形中的应用初探[J].第二军医大学学报,2016,37(2):231-235.DOI:10.16781/j.0258-879x.2016.02.0231. Li YM,Li M,Zhang GY,et al.Application of 3D printing in orthopedics of scoliosis[J].Journal of Second Military Medical University,2016,37(2):231-235.DOI:10.16781/j.0258-879x.2016.02.0231.
7 刘杰,陈晓红,郭士方,等.后路半椎体全切钉棒固定治疗幼儿和青少年先天性脊柱侧凸畸形的对比研究[J].中国矫形外科杂志,2014,22(9):851-853.DOI:10.3977/j.issn.1005-8478.2014.09.18. Liu J,Chen XH,Guo SF,et al.A comparative study of posterior hemivertebral total resection and screw-rod fixation for congenital scoliosis in children and adolescents[J].Chin J Orthop Surg,2014,22(9):851-853.DOI:10.3977/j.issn.1005-8478.2014.09.18.
8 宿玉玺,谢燕,覃佳强,等.Ⅰ期后入路楔形切除术治疗低龄儿童半椎体畸形[J].临床小儿外科杂志,2015,14(3):164-167.DOI:10.3969/j.issn.1671-6353.2015.03.002. Su YX,Xie Y,Qian JQ,et al.Resection of hemivertebra from back route by the first stage in younger children[J].J Clin Ped Sur,2015,14(3):164-167.DOI:10.3969/j.issn.1671-6353.2015.03.002.
9 张啟维,张耀南,孙常太,等.计算机导航下椎弓根置钉与徒手置钉的对比[J].中国组织工程研究,2013,17(9):1579-1585.DOI:10.3969/j.issn.2095-4344.2013.09.009. Zhang QW,Zhang YN,Sun CT,et al.Computer-assisted versus free-hand pedicle screw implantation[J].Chinese Journal of Tissue Engineering Research,2013,17(9):1579-1585.DOI:10.3969/j.issn.2095-4344.2013.09.009.
10 叶斌,梦祥龙,刘玉增,等.徒手置钉技术在脊柱畸形矫正中的准确性与安全性研究[J].脊柱外科杂志,2014,12(1):25-34.DOI:10.3969/j.issn.1672-2957.2014.01.006. Ye B,Meng XL,Liu YZ,et al.Accuracy and safety of pedicle screw placement in spinal deformity correction with free hand technique[J].J Spinal Surg,2014,12(1):25-34.DOI:10.3969/j.issn.1672-2957.2014.01.006.
11 Dankowski R,Baszko A,Sutherland M,et al.3D heart model printing for preparation of percutaneous structural interventions:description of the technology and case report[J].Kardiol Pol,2014,72(6):546-551.DOI:10.5603/KP.2014.0119.
12 Singh H,Shimojima M,Shiratori T,et al.Application of 3D printing technology in increasing the diagnostic performance of enzyme-linked immunosorbent assay (ELISA) for infectious diseases[J].Sensors,2015,15(7):16503-16515.DOI:10.3390/s150716503.
13 庞骄阳,赵岩,肖宇龙,等.3D打印技术在脊柱外科的应用[J].中国组织工程研究,2016,20(4):577-582.DOI:10.3969/j.issn.2095-4344.2016.04.022. Pang JY,Zhao Y,Xiao YL,et al.Application of three-dimensional printing technology in spinal surgery[J].Chinese Journal of Tissue Engineering Research,2016,20(4):577-582.DOI:10.3969/j.issn.2095-4344.2016.04.022.
14 Cartiaux O,Paul L,Francq BG,et al.Improved accuracy with 3D planning and patient-specific instruments during simulated pelvic bone tumor surgery[J].Ann Biomed Eng,2014,42(1):205-213.DOI:10.1007/s10439-013-0890-7.
15 白博,白雪岭,赵小文,等.3D打印在脊柱外科的应用现状与未来[J].中国骨与关节杂志,2017,6(5):321-325.DOI:10.3969/j.issn.2095-252X.2017.05.001. Bai B,Bai XL,Zhao XW,et al.Application of 3D printing technology in spinal surgery:status quo and future[J].Chin J Bone & Joint,2017,6(5):321-325.DOI:10.3969/j.issn.2095-252X.2017.05.001.
16 刘瑞,董乐乐,左强,等.3D 打印定位导向模板在脊柱外科中的应用进展[J].中国数字医学,2015,10(7):33-35.DOI:10.3969/j.issn.1673-7571.2015.07.008. Liu R,Dong LL,Zuo Q,et al.3D printing positioning guide template in spinal surgery[J].China Digital Medicine,2015,10(7):33-35.DOI:10.3969/j.issn.1673-7571.2015.07.008.
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备注/Memo
收稿日期:2019-01-28。
基金项目:北京市属医院科研培育计划项目（编号：PX2020049）
通讯作者:张学军,Email:zhang-x-j04@163.com