多孔隙3D打印人工椎体在脊柱结核重建手术中的应用

Application of multi-pore 3D printed artificial vertebral body in spinal tuberculosis vertebral reconstruction

中文关键词:  脊柱结核  3D打印  椎间融合  肌肉骨骼结核  脊柱感染

英文关键词:Spinal tuberculosis  3D printed  Interbody fusion  Musculoskeletal tuberculosis  Spinal infectious disease

中文摘要:

  【摘要】 目的： 观察3D打印人工椎体应用于脊柱结核椎体重建的临床结果。方法：2018年5月～2021年6月，我科连续住院手术治疗36例脊柱结核患者，其中10例采用病灶清除、3D打印人工椎体重建，包括3例定制假体，7例非定制假体；男性4例，女性6例；年龄26~73岁，中位年龄59岁。颈椎1例，胸椎4例，胸腰段2例，腰椎1例，腰骶段2例。累及3个相邻椎体2例，2个相邻椎体8例。所有患者术前接受2周正规抗结核药物化疗，根据椎体病灶大小规划手术切除范围，个体化设计假体与骨的接触面和固定模式。术后继续口服抗结核药物治疗12~18个月，每月复查血沉、血常规、肝肾功能，定期随访手术部位影像片、VAS疼痛评分、Frankel神经功能、假体融合情况、日常活动功能等。结果：平均随访20.1±9.1个月（12~45个月），手术节段角度术前为-24°~24°，末次随访时为-8°~32°，后凸改善0~32°。术前VAS评分6.4±2.6分，末次随访时为2.0±1.8分；末次随访Frankel脊髓功能分级：8例改善1级或以上，2例维持稳定；除1例耐药结核外，所有假体位置稳定，无假体松动、下沉和移位。假体融合情况Bridwell分级为Ⅰ级2例，Ⅱ级5例，Ⅲ级3例。CT评估界面融合，完全融合1例，初步融合4例，延迟融合4例，不愈合1例。结论：3D打印人工椎体用于脊柱结核具有个体化、即刻稳定性好、融合节段少的特点；临床短期随访疗效确切，假体融合情况需长期随访。

英文摘要:

  【Abstract】 Objectives: To study the clinical outcomes of 3D printed artificial vertebrae in vertebral reconstruction of spinal tuberculosis. Methods: From May 2018 to June 2021, 36 patients with spinal tuberculosis were treated surgically in our department. Among them, 10 cases were treated with debridement surgery and 3D printed artificial vertebral reconstruction, including 3 cases of custom-made prosthesis and 7 cases of non-custom prosthesis. There were 4 males and 6 females, aged 26-73 years, with a median age of 59 years. Tuberculosis affected cervical spine in 1 case, thoracic spine in 4 cases, thoracolumbar spine in 2 cases, lumbar spine in 1 case, and lumbosacral spine in 2 cases. Three adjacent vertebrae were involved in 2 cases, two adjacent vertebral bodies were involved in 8 cases. All patients received anti-tuberculosis chemotherapy for 2 weeks before operation. The extent of excision was planned according to the size of lesions. The contact surface and fixation mode of prosthesis with bone were customized for individuals. Postoperative oral anti-tuberculosis drugs were given for 12-18 months. ESR, blood routine test, liver and kidney function and VAS were followed monthly. Postoperative imaging, VAS pain scales, Frankel neurological function, fusion of prosthesis, daily activity function were regularly followed. Results: All patients were followed up for 12-45 months(mean 20.1±9.1 months). The kyphosis angle of operative segment improved to -8°-32° at final follow-up from -24°-24° before operation, which improved 0-32°. The preoperative VAS pain score was 6.4±2.6, and that at the final follow-up was 2.0±1.8. Frankel classification of spinal cord function at final follow-up: 8 cases improved at least 1 grade; 2 cases remained stable; Except 1 case of drug resistant tuberculosis, positions of all the other prosthesis were stable without loosening, subsidence or displacement. Bridwell interbody fusion grading system: grade Ⅰ, 2 cases; grade Ⅱ, 5 cases; and grade Ⅲ, 3 cases. Interface fusion evaluated by CT: complete fusion in 1 case, preliminary fusion in 4 cases, delayed fusion in 4 cases, 1 case of nonfusion. Conclusions: The 3D printed artificial vertebrae have the features of individualized, good immediate stability and fewer fusion segments in spinal tuberculosis. Its short-term clinical effect is definite, while the prosthesis fusion condition needs long-term follow-up.