3D打印定制钛合金融合器在先天性颈椎侧凸畸形治疗中的应用

The application of 3D printed customized titanium alloy cage in the treatment of congenital cervical scoliosis

中文关键词:  先天性颈椎侧凸  3D打印  钛合金融合器  凹侧撑开技术

英文关键词:Congenital cervical scoliosis  3D printing  Titanium alloy cage  Concave side distraction

中文摘要:

  【摘要】 目的：探讨凹侧撑开技术治疗先天性颈椎侧凸畸形时应用3D打印定制钛合金融合器填充椎间隙的可行性和安全性，并评价其初步疗效。方法：2019年7月~2020年1月，应用一期前后联合入路凹侧撑开、3D打印定制钛合金融合器填充椎间隙治疗7例先天性颈椎侧凸畸形患者，男4例，女3例；年龄6~15岁（9.0±3.0岁）。5例主要骨性畸形为Klippel-Feil综合征，1例为寰椎左侧侧块发育不良，1例为C4节段右侧半椎体。记录手术时间、术中出血量和围手术期神经、血管损伤及切口并发症，观察患者外观和影像学矫形效果。结果：7例患者均顺利完成手术。6例患者行单侧单处撑开，1例患者接受单侧双节段撑开。手术时间326~756min（502.4±149.8min），术中失血量100~600ml（341.4±205.0ml）。椎体间隙使用融合器高度为5~10mm（8.0±1.8mm），小关节间隙使用融合器高度7~12mm（9.5±1.9mm）。所有患者均无术中并发症发生。3例患者术后出现神经根功能障碍，均表现为单侧C5神经根功能障碍，其中2例为凹侧，给予营养神经及功能锻炼治疗，2~6周肌力自行恢复；1例在凸侧，经术后CT检查发现螺钉位置不佳，行翻修手术调整螺钉位置后肌力恢复。随访7~13个月（10.6±2.5个月），末次随访时斜颈得到明显纠正，动力位X线片及CT检查示3D打印定制钛合金融合器与软骨下皮质骨之间接触紧密，未见透亮带，未见融合器位移和下沉；内固定位置均良好，无松动和移位，无假关节形成；畸形矫正率为64.45%。结论：应用凹侧撑开技术治疗先天性颈椎侧凸畸形时采用3D打印定制钛合金融合器填充椎间隙具有较好的可行性和安全性，短期临床随访结果满意。

英文摘要:

  【Abstract】 Objectives: To explore the safety, feasibility, and short-term outcome of applying 3D printed customized titanium alloy cage into intervertebral space, in the surgical treatment of patients with congenital cervical scoliosis. Methods: Between July 2019 and January 2020, seven patients with congenital cervical scoliosis underwent distraction technique of concave side and treated with 3D printed customized titanium alloy cage. 4 were males and 3 were females. Age ranged between 6-15 years old (9.0±3.0 years old). The primary cervical spine deformity was Klippel-Feil syndrome in 5 cases. Of the other two cases, 1 was with malplasia of left lateral mass in the atlas, and the other was diagnosed with C4 right hemi-vertebra. The duration of surgery, estimated blood loss, perioperative neurological, vascular and wound related complications were recorded. Preoperative and postoperative appearance and radiology were observed and compared. Results: All patients′ surgeries were completed successfully. 6 patients received single site distraction and 1 patient received distraction in two sites. The duration of surgery ranged between 326-756min(502.4±149.8min), and the estimated blood loss ranged between 100-600ml(341.4±205.0ml). The height of 3D printed cage applied in the anterior column was 5-10mm(8.0±1.8mm), and the height of that applied between the facet joint was 7-12mm(9.5±1.9mm). No intraoperative complication occurred. 3 patients developed C5 nerve root dysfunction after surgery, with 2 patients on the concave side, and the other on the convex side. In 1 patient, revision surgery for screw adjustment was needed, and got fully recovered after revision surgery, and the other 2 patients recovered by conservative treatment. The follow-up period was 7-13 months(10.6±2.5 months). During the last follow-up, the cervical scoliosis in all patients was corrected significantly. Dynamic X-ray and CT scan showed intact binding between 3D printed cage and cortex. No translucent zone, subsidence, loosening, or migration of prosthesis was discovered. No pseudoarthrosis was discovered. The correction rate was 64.45%. Conclusions: The application of 3D printed customized titanium alloy cage in the treatment of congenital cervical scoliosis was with good feasibility and clinical safety. Short-term follow-up showed excellent results with a promising future.