PDF(Pubmed)
Abstract：
BACKGROUND: The surgical treatment of severe and complex adult spinal deformity (ASD) commonly required three-column osteotomy (3-CO), which was technically demanding with high risk of neurological deficit. Personalized three dimensional (3D)-printed guide template based on preoperative planning has been gradually applied in 3-CO procedure. The purpose of this study was to compare the efficacy, safety, and precision of 3D-printed osteotomy guide template and free-hand technique in the treatment of severe and complex ASD patients requiring 3-CO.
METHODS: This was a single-centre retrospective comparative cohort study of patients with severe and complex ASD (Cobb angle of scoliosis > 80° with flexibility < 25% or focal kyphosis > 90°) who underwent posterior spinal fusion and 3-CO between January 2020 to January 2023, with a minimum 12 months follow-up. Personalized computer-assisted three-dimensional osteotomy simulation was performed for all recruited patients, who were further divided into template and non-template groups based on the application of 3D-printed osteotomy guide template according to the surgical planning. Patients in the two groups were age- and gender- propensity-matched. The radiographic parameters, postoperative neurological deficit, and precision of osteotomy execution were compared between groups.
RESULTS: A total of 40 patients (age 36.53 ± 11.98 years) were retrospectively recruited, with 20 patients in each group. The preoperative focal kyphosis (FK) was 92.72° ± 36.77° in the template group and 93.47° ± 33.91° in the non-template group, with a main curve Cobb angle of 63.35° (15.00°, 92.25°) and 64.00° (20.25°, 99.20°), respectively. Following the correction surgery, there were no significant differences in postoperative FK, postoperative main curve Cobb angle, correction rate of FK (54.20% vs. 51.94%, P = 0.738), and correction rate of main curve Cobb angle (72.41% vs. 61.33%, P = 0.101) between the groups. However, the match ratio of execution to simulation osteotomy angle was significantly greater in the template group than the non-template group (coronal: 89.90% vs. 74.50%, P < 0.001; sagittal: 90.45% vs. 80.35%, P < 0.001). The operating time (ORT) was significantly shorter (359.25 ± 57.79 min vs. 398.90 ± 59.48 min, P = 0.039) and the incidence of postoperative neurological deficit (5.0% vs. 35.0%, P = 0.018) was significantly lower in the template group than the non-template group.
CONCLUSIONS: Performing 3-CO with the assistance of personalized 3D-printed guide template could increase the precision of execution, decrease the risk of postoperative neurological deficit, and shorten the ORT in the correction surgery for severe and complex ASD. The personalized osteotomy guide had the advantages of 3D insight of the case-specific anatomy, identification of osteotomy location, and translation of the surgical planning or simulation to the real surgical site.
METHODS: This was a single-centre retrospective comparative cohort study of patients with severe and complex ASD (Cobb angle of scoliosis > 80° with flexibility < 25% or focal kyphosis > 90°) who underwent posterior spinal fusion and 3-CO between January 2020 to January 2023, with a minimum 12 months follow-up. Personalized computer-assisted three-dimensional osteotomy simulation was performed for all recruited patients, who were further divided into template and non-template groups based on the application of 3D-printed osteotomy guide template according to the surgical planning. Patients in the two groups were age- and gender- propensity-matched. The radiographic parameters, postoperative neurological deficit, and precision of osteotomy execution were compared between groups.
RESULTS: A total of 40 patients (age 36.53 ± 11.98 years) were retrospectively recruited, with 20 patients in each group. The preoperative focal kyphosis (FK) was 92.72° ± 36.77° in the template group and 93.47° ± 33.91° in the non-template group, with a main curve Cobb angle of 63.35° (15.00°, 92.25°) and 64.00° (20.25°, 99.20°), respectively. Following the correction surgery, there were no significant differences in postoperative FK, postoperative main curve Cobb angle, correction rate of FK (54.20% vs. 51.94%, P = 0.738), and correction rate of main curve Cobb angle (72.41% vs. 61.33%, P = 0.101) between the groups. However, the match ratio of execution to simulation osteotomy angle was significantly greater in the template group than the non-template group (coronal: 89.90% vs. 74.50%, P < 0.001; sagittal: 90.45% vs. 80.35%, P < 0.001). The operating time (ORT) was significantly shorter (359.25 ± 57.79 min vs. 398.90 ± 59.48 min, P = 0.039) and the incidence of postoperative neurological deficit (5.0% vs. 35.0%, P = 0.018) was significantly lower in the template group than the non-template group.
CONCLUSIONS: Performing 3-CO with the assistance of personalized 3D-printed guide template could increase the precision of execution, decrease the risk of postoperative neurological deficit, and shorten the ORT in the correction surgery for severe and complex ASD. The personalized osteotomy guide had the advantages of 3D insight of the case-specific anatomy, identification of osteotomy location, and translation of the surgical planning or simulation to the real surgical site.
摘要：
背景：严重和复杂的成人脊柱畸形（ASD）的手术治疗通常需要三柱截骨术（3-CO），这在技术上要求很高，神经缺陷的风险很高。基于术前规划的个性化三维打印引导模板已逐步应用于3-CO手术中。这项研究的目的是比较疗效，安全,3D打印截骨引导模板和徒手技术在治疗需要3-CO的严重和复杂ASD患者中的精确性。
方法：这是一项单中心回顾性队列研究，研究对象为2020年1月至2023年1月期间接受后路脊柱融合术和3-CO治疗的重度复杂ASD患者（脊柱侧凸Cobb角>80°，柔韧性<25%或局灶性后凸>90°），随访时间至少为12个月。对所有招募的患者进行个性化的计算机辅助三维截骨模拟，根据手术计划，应用3D打印截骨引导模板将其进一步分为模板组和非模板组。两组患者的年龄和性别倾向匹配。射线照相参数，术后神经功能缺损,比较两组截骨手术的精确度。
结果：回顾性招募了40名患者（年龄36.53±11.98岁），每组20名患者。术前局灶性后凸(FK)模板组为92.72°±36.77°,非模板组为93.47°±33.91°,主曲线Cobb角为63.35°（15.00°，92.25°)和64.00°(20.25°,99.20°),分别。矫正手术后,术后FK无显著差异,术后主曲线Cobb角,FK的矫正率(54.20%vs.51.94%,P=0.738),和主曲线Cobb角的校正率（72.41%vs.61.33%，组间P=0.101）。然而,模板组的执行与模拟截骨角度的匹配率明显高于非模板组（冠状：89.90％vs.74.50%,P<0.001；矢状：90.45%vs.80.35%,P<0.001)。手术时间（ORT）明显缩短（359.25±57.79minvs.398.90±59.48分钟,P=0.039）和术后神经功能缺损的发生率（5.0％vs.35.0%,P=0.018），模板组明显低于非模板组。
结论：在个性化3D打印指南模板的帮助下执行3-CO可以提高执行精度，降低术后神经功能缺损的风险，并缩短严重和复杂ASD矫正手术中的ORT。个性化截骨引导具有3D洞察特定病例解剖的优势，确定截骨位置，并将手术计划或模拟转换为真实的手术部位。
方法：这是一项单中心回顾性队列研究，研究对象为2020年1月至2023年1月期间接受后路脊柱融合术和3-CO治疗的重度复杂ASD患者（脊柱侧凸Cobb角>80°，柔韧性<25%或局灶性后凸>90°），随访时间至少为12个月。对所有招募的患者进行个性化的计算机辅助三维截骨模拟，根据手术计划，应用3D打印截骨引导模板将其进一步分为模板组和非模板组。两组患者的年龄和性别倾向匹配。射线照相参数，术后神经功能缺损,比较两组截骨手术的精确度。
结果：回顾性招募了40名患者（年龄36.53±11.98岁），每组20名患者。术前局灶性后凸(FK)模板组为92.72°±36.77°,非模板组为93.47°±33.91°,主曲线Cobb角为63.35°（15.00°，92.25°)和64.00°(20.25°,99.20°),分别。矫正手术后,术后FK无显著差异,术后主曲线Cobb角,FK的矫正率(54.20%vs.51.94%,P=0.738),和主曲线Cobb角的校正率（72.41%vs.61.33%，组间P=0.101）。然而,模板组的执行与模拟截骨角度的匹配率明显高于非模板组（冠状：89.90％vs.74.50%,P<0.001；矢状：90.45%vs.80.35%,P<0.001)。手术时间（ORT）明显缩短（359.25±57.79minvs.398.90±59.48分钟,P=0.039）和术后神经功能缺损的发生率（5.0％vs.35.0%,P=0.018），模板组明显低于非模板组。
结论：在个性化3D打印指南模板的帮助下执行3-CO可以提高执行精度，降低术后神经功能缺损的风险，并缩短严重和复杂ASD矫正手术中的ORT。个性化截骨引导具有3D洞察特定病例解剖的优势，确定截骨位置，并将手术计划或模拟转换为真实的手术部位。
