| Objective:There is preliminary application of intra-vertebral body support implants at the intersection of the superior transverse and superior articular eminence in the treatment of thoracolumbar burst fracture(TBF).In the process of applying this new bone grafting method,the puncture is positioned through the anatomical point,and then the angle of travel is adjusted to reach the bone grafting point.The procedure may not be performed under direct vision and requires intraoperative x-ray to clarify the location if necessary.3D printing technology is widely used in spine surgery such as preoperative planning,template guidance,etc.In this study,we hope to better plan the bone grafting path to make intra-vertebral body support implants at the intersection of the superior transverse and superior articular eminence perfect through 3D printing technology.Methods:Case inclusion criteria:① Patients with clear history of trauma and less than 14 days post-injury surgery,② Patients aged 18-65 years old,③ Patients diagnosed as single segmental Denis A and B thoracolumbar burst fracture,④ The follow-up of the whole process was more than 1 year,⑤ Patients with partial or no spinal neurological symptoms(Frankel classification C,D,E),⑥ Patients’ TLICS score were more than or equal to 5.Case exclusion criteria:①Patients diagnosed as multiple vertebral fractures,②Patients diagnosed as severe osteoporosis,③ Patients with combined cerebral infarction or other serious complications that cannot tolerate surgery,④Patients with fractures caused by other causes such as tumors,⑤ Patients with complete neurological impairment in both lower extremities.Sixty-five patients with thoracolumbar burst fractures admitted to the Department of Spine Surgery between December 2020 and March 2022 were included as study subjects.The patients were divided into two groups.Control group:31 patients without 3D printing.Observation group:34 patients underwent 3D printing.The operative time,intraoperative bleeding,frequency of intraoperative X-ray fluoroscopy,visual analogue scale(VAS)of pain,Oswestry dability index(ODI)before and after surgery,sagittal Cobb angle of X-ray of injured spine before and after surgery,and height ratio of anterior margin of injured spine before and after surgery were compared between the two groups.Data analysis was performed using SPSS 26.0 computer application software.Measurement data is indicated by the symbol mean ± standard deviation and comparison of that between the two groups are performed by independent sample t test,multiple sets of comparison between the two groups are performed by the analysis of variance;Statistical data were represented by case numbers,and comparison between groups was performed by chi-square test or Fisher exact test.Data differences were statistically significant at P<0.05.Results:1.In terms of intraoperative conditions:the operating time,frequency of intraoperative X-ray fluoroscopy and intraoperative bleeding in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).2.In terms of VAS and ODI scores:the differences in VAS and ODI scores between the two groups of patients at 2 weeks,6 months and 12 months after surgery were not statistically significant(P>0.05).3.In terms of Injured spine X-ray sagittal Cobb angle:the differences in the injured spine X-ray sagittal Cobb angle between the two groups of patients at 2 weeks,6 months and 12 months after surgery were not statistically significant(P>0.05).4.In terms of height ratio of anterior margin of injured spine:the differences in the injured spine ratio of anterior margin of injured spine between the two groups of patients at 2 weeks,6 months and 12 months after surgery were not statistically significant(P>0.05).5.In terms of perioperative adverse conditions and complications:A small number of patients in the two groups developed fever,constipation,nausea and vomiting,cerebrospinal fluid leakage and other adverse conditions after surgery,and there was no significant difference between the two groups in the above conditions(P>0.05).During the follow-up period,there were no complications such as incision infection,loose fracture internal fixation,or sensorimotor abnormalities in both groups.Incision healing standards were met in both groups.The two groups of patients had one-stage healing of the incision and at least one level of improvement in nerve injury symptoms.Conclusion:Based on the reconstruction of fracture model with 3D printing technology,it can not only observe the fracture morphology before surgery,understand the relevant anatomical points of the patient’s vertebral body,simulate the insertion point of bone graft,and estimate the amount of bone graft,but also visually see the path of bone graft,which can make up for the shortcomings of bone graft that cannot be seen directly during surgery.The intraoperative application of bone graft guide can reduce the intraoperative time and intraoperative fluoroscopy times to a certain extent.It plays an auxiliary role in the operation and has a good potential for clinical promotion. |
