背景:神经压迫症状和脊柱不稳定,由于脊柱转移,显著影响患者的生活质量。3D打印椎体被认为是脊柱肿瘤整块切除后重建骨缺损的有效方法。这种方法的优点在于其定制的形状和最内部的多孔结构,这促进了骨向内生长并导致减少了术后并发症。
目的:本研究的目的是评估3D打印自动稳定人工椎骨在胸腰椎转移瘤整块切除和重建中的有效性。
方法:本研究纳入了基于Weinstein-Boriani-Biagini手术分期系统的胸腰椎转移瘤整块切除术的患者,2019年1月至2021年4月。将患者分为两组:观察组,使用3D打印的自动稳定椎体重建,和对照组,用钛笼和同种异体骨处理。患者的评估标准包括评估植入物沉降,器械相关并发症,VAS评分,脊髓损伤的Frankel分级.
结果:中位随访期为21.8个月(范围12-38个月)。在患者中,10收到定制的3D打印人造椎体,而其余的10只收到了一个钛笼。观察组手术时间明显减少,术中失血,术后引流量与对照组比较(P<0.05)。在最后的后续行动中,观察组平均种植下沉量为1.8±2.1mm,对照组为5.2±5.1mm(P<0.05)。两组患者术前视觉模拟量表(VAS)评分差异无统计学意义,24h,3个月,术后1年(P<0.05)。两组脊髓功能改善情况无统计学差异。
结论:在胸腰椎转移瘤整块切除后,利用3D打印的自动稳定人工椎骨进行重建似乎是一个可行且可靠的选择。3D打印假体的假体下沉发生率低,可以提供即时和强大的稳定性。
BACKGROUND: Nerve compression symptoms and spinal instability, resulting from spinal metastases, significantly impact the quality of life for patients. A 3D-printed vertebral body is considered an effective approach to reconstruct bone defects following en bloc resection of spinal tumors. The advantage of this method lies in its customized shape and innermost porous structure, which promotes bone ingrowth and leads to reduced postoperative complications.
OBJECTIVE: The purpose of this study is to assess the effectiveness of 3D-printed auto-stable artificial vertebrae in the en bloc resection and reconstruction of thoracolumbar metastases.
METHODS: This study included patients who underwent en bloc resection of thoracolumbar metastases based on the Weinstein-Boriani-Biagini surgical staging system, between January 2019 and April 2021. The patients were divided into two groups: the observation group, which was reconstructed using 3D-printed auto-stable vertebral bodies, and the control group, treated with titanium cages and allograft bone. Evaluation criteria for the patients included assessment of implant subsidence, instrumentation-related complications, VAS score, and Frankel grading of spinal cord injury.
RESULTS: The median follow-up period was 21.8 months (range 12-38 months). Among the patients, 10 received a customized 3D-printed artificial vertebral body, while the remaining 10 received a titanium cage. The observation group showed significantly lower operation time, intraoperative blood loss, and postoperative drainage compared to the control group (P < 0.05). At the final follow-up, the average implant subsidence was 1.8 ± 2.1 mm for the observation group and 5.2 ± 5.1 mm for the control group (P < 0.05). The visual analog scale (VAS) scores were not statistically different between the two groups at preoperative, 24 h, 3 months, and 1 year after the operation (P < 0.05). There were no statistically significant differences in the improvements of spinal cord functions between the two groups.
CONCLUSIONS: The utilization of a 3D-printed auto-stable artificial vertebra for reconstruction following en bloc resection of thoracolumbar metastases appears to be a viable and dependable choice. The low occurrence of prosthesis subsidence with 3D-printed prostheses can offer immediate and robust stability.