3d打印钛椎体治疗脊髓型颈椎病：围手术期、影像学和临床结果的比较分析

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics Pub Date : 2025-06-17 DOI:10.1016/j.jor.2025.06.015

Gelin Zhang , Ting Zhang , Xuyan Zhang , Yurui Guo , Liying Fan , Bin Cheng , Leilei Pei , Jun Dong

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引用次数: 0

摘要

目的采用钛网笼（TMC）行颈椎前路椎体切除术融合术（ACCF）伴有较高的沉陷率。本研究旨在评估在ACCF手术中使用3d打印钛椎体作为TMC替代品的潜在优势。方法回顾性分析2017年3月至2023年6月在我院行ACCF的患者。记录患者人口统计学、手术参数（手术时间和出血量）、功能评估（Barthel评分、Morse跌倒量表（MFS）、颈椎前路切除术指数（aCCI））、住院时间、费用、术后并发症、计划外再手术、ICU入院率和患者报告的结果（日本骨科协会（JOA）评分、视觉模拟量表（VAS）评分、颈部残疾指数（NDI）评分）。通过颈椎侧位x线评估影像学结果，包括C2-C7 Cobb角、节段性前凸和沉降。采用卡方检验和Mann-Whitney检验进行统计分析。结果共纳入92例患者，其中3d椎体组48例，TMC组44例。各组间基线特征具有可比性。与TMC组相比，3d椎体组明显缩短了手术时间，减少了出血量，改善了功能评分(p <；0.05)。术后，3d椎体组在一周和最后随访时JOA和VAS评分均较低。一周的NDI评分比较，但随访时TMC组的NDI评分明显更高。虽然各组间节段性前凸保持相似，但随访时C2-C7 Cobb角表现出显著差异。TMC组平均下陷2.5 mm，而3d椎体组的下陷最小。结论与TMC植入物相比，3d打印钛椎体在ACCF手术中的应用提供了更好的围手术期参数、影像学结果和临床评分。进一步的长期研究是有必要的，以确定3d打印椎骨的扩展好处。在解释研究结果时应考虑局限性，并有必要进行前瞻性随机对照研究来验证我们的结论。

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3D-printed titanium vertebra in the treatment of cervical spondylotic myelopathy: A comparative analysis of perioperative, radiographic, and clinical outcomes

Objective

Anterior cervical corpectomy and fusion (ACCF) using a titanium mesh cage (TMC) is associated with a high rate of subsidence. This study aims to evaluate the potential advantages of utilizing 3D-printed titanium vertebrae as an alternative to TMC in ACCF procedures.

Methods

A retrospective analysis was conducted on patients who underwent ACCF at our hospital between March 2017 and June 2023. Patient demographics, surgical parameters (operation duration and blood loss), functional assessments (Barthel score, Morse Fall Scale (MFS), anterior cervical corpectomy index (aCCI)), hospitalization duration, costs, postoperative complications, unplanned reoperations, ICU admissions, and patient-reported outcomes (Japanese Orthopedic Association (JOA) score, Visual Analog Scale (VAS) score, Neck Disability Index (NDI) score) were recorded. Radiographic outcomes, including C2-C7 Cobb angles, segmental lordosis, and subsidence, were assessed via lateral cervical spine X-rays. Statistical analysis was performed using the Chi-square test and Mann-Whitney test.

Results

A total of 92 patients were included in the study, with 48 patients in the 3D-vertebra group and 44 in the TMC group. Baseline characteristics were comparable between groups. The 3D-vertebra group demonstrated significantly shorter operative time, reduced blood loss, and improved functional scores compared to the TMC group (p < 0.05). Postoperatively, the 3D-vertebra group exhibited lower JOA and VAS scores at both one-week and final follow-up. NDI scores were comparable at one week but were significantly higher in the TMC group at follow-up. While segmental lordosis remained similar between groups, C2-C7 Cobb angles showed significant differences at follow-up. The TMC group experienced an average subsidence of 2.5 mm, whereas the 3D-vertebra group had minimal subsidence.

Conclusion

The use of 3D-printed titanium vertebrae in ACCF surgery offers superior perioperative parameters, radiographic outcomes, and clinical scores compared to TMC implants. Further long-term studies are warranted to establish the extended benefits of 3D-printed vertebrae. Limitations should be considered when interpreting the findings, and prospective, randomized controlled studies are warranted to validate our conclusions.

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来源期刊

Journal of orthopaedics ORTHOPEDICS-

CiteScore

3.50

自引率

6.70%

发文量

202

审稿时长

56 days

期刊介绍： Journal of Orthopaedics aims to be a leading journal in orthopaedics and contribute towards the improvement of quality of orthopedic health care. The journal publishes original research work and review articles related to different aspects of orthopaedics including Arthroplasty, Arthroscopy, Sports Medicine, Trauma, Spine and Spinal deformities, Pediatric orthopaedics, limb reconstruction procedures, hand surgery, and orthopaedic oncology. It also publishes articles on continuing education, health-related information, case reports and letters to the editor. It is requested to note that the journal has an international readership and all submissions should be aimed at specifying something about the setting in which the work was conducted. Authors must also provide any specific reasons for the research and also provide an elaborate description of the results.