标题：虚拟仿真结合3D打印技术在脊柱骨折手术中的应用

      作者：伍汉强，郑仕强，伍家志    广宁县中医医院骨伤科，广东 肇庆 526600

      卷次： 2022年33卷19期

      【摘要】 目的 探讨虚拟仿真结合 3D打印技术在脊柱骨折手术中的应用效果。方法 选择 2018年 1月至2020年12月广宁县中医医院骨伤科收治的80例脊柱骨折患者为研究对象，根据随机数表法分为观察组和对照组各40例。两组患者均接受椎弓根螺钉内固定术治疗，对照组患者术中使用常规置钉方法，观察组患者术中使用虚拟仿真结合3D打印技术进行置钉。比较两组患者围术期情况，术前、术后1个月、3个月、6个月时的日本骨科协会评估治疗(JOA)评分的变化，术前和术后6个月伤椎前后缘高度比和矢状位后凸Cobb角的变化，并比较两组患者术后并发症发生情况。结果 观察组患者的手术时间、术中出血量、术中透视次数分别为(93.11±8.52) min、(98.16±7.51) mL、(12.01±2.37)次，明显短于(少)于对照组的(120.63±15.71) min、(134.25±13.26) mL、(14.98±2.04)次，置钉准确率为90.00%，明显高于对照组的70.00%，差异均有统计学意义(P<0.05)；手术后，两组患者的 JOA评分均明显升高，且观察组患者术后1个月、3个月、6个月时 JOA评分分别为(19.56±2.88)分、(23.11±2.32)分、(25.81±2.47)分，明显高于对照组的(17.15±2.17)分、(20.08±2.15)分、(22.36±2.04)分，差异均有统计学意义(P<0.05)；术后6个月时，两组患者的伤椎前后缘高度比均高于术前，矢状位后凸Cobb角均低于术前，且观察组患者伤椎前后缘高度比为(89.55±6.11)%，明显高于对照组的(80.32±7.86)%，矢状位后凸Cobb角为(9.16±1.33)°，明显低于对照组的(11.85±1.52)°，差异均有统计学意义(P<0.05)；观察组患者术后并发症总发生率为2.50%，明显低于对照组的15.00%，差异有统计学意义(P<0.05)。结论 虚拟仿真结合3D打印技术在脊柱骨折手术中的应用效果优于常规置钉方法，其不仅提高手术效果，促进患者术后功能恢复，还可减少并发症发生，值得临床推广。
      【关键词】 脊柱骨折；椎弓根螺钉内固定术；虚拟仿真；3D打印；日本骨科协会评估治疗分数；并发症
      【中图分类号】 R683.1 【文献标识码】 A 【文章编号】 1003—6350（2022）19—2500—04

Application of virtual simulation combined with 3D printing technology in spinal fracture surgery.
WUHan-qiang, ZHENG Shi-qiang, WU Jia-zhi. Department of Orthopedics and Traumatology, Guangning Hospital ofTraditional Chinese Medicine, Zhaoqing 526600, Guangdong, CHINA
【Abstract】 Objective To explore the application effect of virtual simulation combined with 3D printing tech-nology in spinal fracture surgery. Methods Eighty patients with spinal fracture admitted in Guangning Hospital of Tra-ditional Chinese Medicine from January 2018 to December 2020 were selected. According to the random number tablemethod, they were divided into an observation group and a control group, each with 40 patients. Based on pedicle screwfixation, patients in the control group used conventional method for nail placement, and patients in the observation groupused virtual simulation combined with 3D printing technology for nail placement. The perioperative situation, the chang-es of Japanese Orthopaedic Association (JOA) score before operation, at 1 month, 3 months, and 6 months after opera-tion, the changes of height ratio of anterior and posterior edge of injured cone, sagittal posterior convex Cobb angle be-fore operation and at 6 months after operation, and the incidence of postoperative complications were compared betweenthe two groups. Results The operative time, intraoperative blood loss, and intraoperative fluoroscopy times in the ob-servation group were (93.11±8.52) min, (98.16±7.51) mL, and (12.01±2.37) times, respectively, which were significantlyshorter/lower than (120.63±15.71) min, (134.25±13.26) mL, (14.98±2.04) times in the control group; the accuracy ofnail placement was 90.00%, which was significantly higher than 70.00% in the control group; the differences were sta-tistically significant (P<0.05). After surgery, the JOA score in two groups were increased significantly, and at 1 month,3 months and 6 months after operation, the JOA scores in the observation group were (19.56±2.88) points, (23.11±2.32) points, and (25.81±2.47) points, which were significantly higher than (17.15±2.17) points, (20.08±2.15) points,and (22.36±2.04) points in the control group (P<0.05). At 6 months after operation, the height ratio of anterior and poste-rior edge of injured cone in two groups were higher than that before surgery, and the Cobb Angle of sagittal kyphosiswere lower than that before surgery; the height ratio of anterior and posterior edge of injured cone in the observationgroup was (89.55±6.11)%, which was significantly higher than (80.32±7.86)% in the control group; the Cobb Angle ofsagittal kyphosis was (9.16±1.33)°, which was significantly lower than (11.85±1.52)° in the control group; the differenc-es were statistically significant (P<0.05). The total incidence of postoperative complications in the observation group