A Comparative Study Of Digital Design And 3D Printing In Vertebroplasty

Objective: To study the feasibility of digital design combined with 3D printing technology to make personalized navigation template in percutaneous kyphoplasty(PKP)and evaluate its therapeutic effect.Methods : From June 2019 to June 2020,60 patients with osteoporotic vertebral compression fracture(OVCF)diagnosed by minimally invasive spine surgery in the Second Affiliated Hospital of Inner Mongolia Medical University were selected as the research objects according to the inclusion and exclusion criteria.The 60 patients were randomly divided into the control group and the test group with 30 cases each,the baseline data of age,gender,bone mineral density and fractured vertebral body distribution of the two groups were statistically analyzed.It was confirmed that the difference was not statistically significant(P > 0.05),which was comparable.The control group was operated on traditional PKP,and the test group was assisted by navigation template.Before operation,CT data of fractured vertebral body were imported into Mimics software to reconstruct the fractured vertebral body,simulate the operation,establish the puncture path combined with the actual fracture situation of fractured vertebral body,set the key parameters in puncture,such as ideal puncture arrival point,puncture needle angle,puncture depth and body surface puncture entry point,and then the skin and surface markers of the patient’s back were reconstructed to construct a personalized navigation template that fits the patient’s back.Combined with the above puncture parameters,the position and direction of the puncture hole were established on the navigation template,and the personalized percutaneous puncture navigation template matching each case was obtained.After printing by 3D printer,it was used to assist PKP puncture during the operation.The control group and the test group were all performed by unilateral puncture,and the same operator and assistant were used for practical operation.One day after operation,all patients in the two groups were reexamined with CT to reconstruct the fractured vertebral body.The bone cement diffusion volume and the vertebral body volume of the injured vertebral body were measured in Mimics software,and then calculate the bone cement diffusion volume ratio(bone cement diffusion volume ratio = bone cement diffusion volume / vertebral body volume of the injured vertebral body).The fluoroscopy times of puncture needle reaching the ideal puncture point,the total fluoroscopy times during the operation,the time of puncture needle reaching the ideal puncture point,the total operation time,the amount of bone cement injection,the leakage of bone cement,the visual analogue scale(VAS)before and 1 day after the operation,and the bone cement diffusion volume ratio after operation were recorded and counted.Finally,the above indicators of the two groups were statistically analyzed.Results: The operation of the two groups were successfully completed.The navigation template of the test group fit well with the skin of the patients’ waist and back,and there were no adverse reactions in all patients.The test group was significantly less than the control group in the fluoroscopy times of puncture needle reaching the ideal puncture point,the total fluoroscopy times during the operation,the time of puncture needle reaching the ideal puncture point and the total operation time,the differences was statistically significant(P < 0.001).There was no statistical difference in the amount of bone cement injected between the two groups(P > 0.05).There were 4 cases of bone cement leakage in the control group(13.33%,4 / 30),no leakage into the spinal canal,no adverse reactions,and no bone cement leakage in the test group(0%,0 / 30),there was statistical difference in the leakage rate of bone cement between the two groups(P < 0.05).There was no significant difference in preoperative VAS score between the control group and the test group(P > 0.05),one day after operation,VAS scores of the two groups were significantly lower than those before operation(P < 0.001),the VAS score of the test group was lower than that of the control group one day after operation,and the difference was statistically significant(P < 0.05).The bone cement diffusion volume ratio in the test group was higher than that in the control group(P < 0.05).Conclusion: Preoperative digital design combined with 3D printing technology to make personalized navigation template assisted PKP surgery can achieve accurate puncture,significantly reduce the number of intraoperative fluoroscopy and operation time,reduce the incidence of bone cement leakage,and is better than traditional PKP surgery in pain relief,and help bone cement achieve better diffusion in the injured vertebra,and improve the comprehensive treatment level of OVCF patients,it is worthy of wide promotion in clinical practice.