中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (18): 2837-2841.doi: 10.12307/2023.394

• 数字化骨科 digital orthopedics • 上一篇    下一篇

3D打印微孔钛合金融合器用于颈椎前路减压植骨融合对颈椎解剖学及应激激素的影响

蒋成明1,蒋赛男2,唐  烨1,蒋  林1   

  1. 长沙市第一医院,1脊柱外科,2科教科,湖南省长沙市   410005
  • 收稿日期:2022-04-18 接受日期:2022-07-14 出版日期:2023-06-28 发布日期:2022-09-17
  • 通讯作者: 蒋赛男,长沙市第一医院科教科,湖南省长沙市 410005
  • 作者简介:蒋成明,男,1976年生,湖南省益阳市人,硕士,副主任医师,主要从事脊柱疾病的诊断和治疗研究。
  • 基金资助:
    吴阶平医学基金会一般项目(320-2745-16-178),项目负责人:蒋林

Efficacy of 3D printed microporous titanium fusion device applied to anterior cervical decompression graft fusion and its effects on cervical spine anatomy and stress hormones

Jiang Chengming1, Jiang Sainan2, Tang Ye1, Jiang Lin1   

  1. 1Department of Spine Surgery, 2Department of Science and Education, The First Hospital of Changsha, Changsha 410005, Hunan Province, China
  • Received:2022-04-18 Accepted:2022-07-14 Online:2023-06-28 Published:2022-09-17
  • Contact: Jiang Sainan, Department of Science and Education, The First Hospital of Changsha, Changsha 410005, Hunan Province, China
  • About author:Jiang Chengming, Master, Associate chief physician, Department of Spine Surgery, The First Hospital of Changsha, Changsha 410005, Hunan Province, China
  • Supported by:
    General Project of Wu Jieping Medical Foundation, No. 320-2745-16-178 (to JL)

摘要:

文题释义:
颈椎病:是由颈椎退行性病变产生的临床综合征,主要表现为颈背疼痛、僵硬、上肢放射性疼痛等症状,前路减压植骨融合是治疗该病主要术式之一,可解除压迫、恢复生物解剖结构。
3D打印技术:是近年新兴技术,以数字模型为基础,将生物材料按路径堆积成形并可通过微孔调整,使3D打印椎间融合器的弹性模量与松质骨、椎体皮质骨接近,可避免难以与骨组织紧密结合的弊端,已在关节置换、骨折内固定中得到有效应用。

背景:3D打印微孔钛合金融合器具备与松质骨、椎体皮质骨较为接近的弹性模量,进一步分析其临床应用效果,对颈椎手术中融合器的合理选择具有重要的指导意义。
目的:探讨3D打印微孔钛合金融合器在颈椎前路减压植骨融合中的应用效果,以及其对患者颈椎解剖学、应激激素的影响。
方法:选择2016年3月至2021年9月长沙市第一医院收治的脊髓型颈椎病患者90例,男46例,女44例,年龄(46.85±9.74)岁,采用随机数字表法分为2组,对照组(n=45)颈椎前路减压植骨融合术中置入聚醚醚酮椎间融合器与自体骨,观察组(n=45)颈椎前路减压植骨融合术中置入3D打印微孔钛合金融合器。术后1周,采用日本骨科协会脊髓功能量表评价疗效;术后3 d及3个月,拍摄颈椎X射线片记录颈部解剖学指标;术后1,3 d,采集静脉血检测去甲肾上腺素、皮质醇水平;术后3个月,采用颈部失能指数、日常生活能力量表评价患者肢体功能状态。
结果与结论:①两组临床疗效优良率比较差异无显著性义(P > 0.05);②观察组术后3个月的颈椎融合节段高度、融合节段Cobb角、T1倾斜角均高于对照组(P < 0.001),术后1,3 d的皮质醇、去甲肾上腺素水平均低于对照组(P < 0.001);③观察组术后3个月的颈部失能指数低于对照组(P < 0.001),日常生活能力量表评分高于对照组(P < 0.001);④结果表明,3D打印微孔钛合金融合器应用于颈椎前路减压植骨融合中可取得良好的效果,能减轻机体应激、改善肢体功能,同时在保持颈椎解剖形态方面具有优势。

https://orcid.org/0000-0002-6915-0109 (蒋成明) 

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程

关键词: 3D打印, 微孔钛合金融合器, 聚醚醚酮椎间融合器, 脊髓型颈椎病, 颈椎前路减压植骨融合, 应激激素, 生物相容性

Abstract: BACKGROUND: 3D printed intervertebral fusion has elastic modulus closer to cancellous bone and vertebral cortical bone, and further analysis of the effect of its clinical application is an important guideline for the reasonable selection of fusion device for cervical spine surgery.  
OBJECTIVE: To investigate the effectiveness of 3D printed microporous titanium fusion in anterior cervical decompression graft fusion and its effects on cervical spine anatomy and stress hormones.
METHODS: Totally 90 patients with cervical spondylotic myelopathy in The First Hospital of Changsha from March 2016 to September 2021 were selected, including 46 males and 44 females, aged (46.85±9.74) years old. They were divided into two groups by the random number table method. Patients in the control group (n=45) received anterior cervical decompression graft fusion with a polyetheretherketone interbody fusion and autogenous bone. Patients in the observation group (n=45) received anterior cervical decompression graft fusion with a 3D printed microporous titanium fusion. One week after the operation, the Japanese Orthopaedic Association Spinal Cord Function Scale was used to evaluate the curative effect. At 3 days and 3 months after the operation, cervical spine X-ray films were taken to record the anatomical indexes of the neck. At 1 and 3 days after operation, venous blood was collected to detect the levels of norepinephrine and cortisol. At 3 months after the operation, the neck disability index and the daily living ability scale were used to evaluate the limb function status of the patients.  
RESULTS AND CONCLUSION: (1) There was no significant difference in the excellent and good rate of clinical efficacy between the two groups (P > 0.05). (2) The height of the fused segment, Cobb angle of the fused segment, and T1 tilt angle of the observation group were higher than those of the control group at 3 months after surgery (P < 0.001). The cortisol and norepinephrine levels of the observation group were lower than those of the control group at 1 and 3 days after surgery (P < 0.001). (3) The cervical dysfunction index of the observation group was lower than that of the control group at 3 months after surgery (P < 0.001). Activity of daily living of the observation group was higher than that of the control group at 3 months after surgery (P < 0.001). (4) It can be seen that 3D printed microporous titanium alloy fusion device applied to anterior cervical decompression and implant fusion achieved good results, which can reduce the stress of the body and improve limb function and have more advantages in maintaining cervical spine anatomy.

Key words: 3D printing, microporous titanium fusion, polyetheretherketone intervertebral fusion, cervical spondylotic myelopathy, anterior cervical decompression and bone fusion, stress hormone, biocompatibility

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