Application of 3D Printed Guide Template in Posterior Lumbar Fusion with Osteoporosis

Chen Huiguo; Shao Rongxue; Ruan Liqi; Le Jun; Hu Jingtao; Zhou Hui

Abstract：Objective To explore the effectiveness,safety,and intraoperative precautions of 3D printed cortical bone trajectory(CBT)guiding template in lumbar CBT fixation surgeryMethods The clinical data of 74 patients with osteoporotic lumbar degenerative diseases treated in Hangzhou Hospital of Traditional Chinese Medicine from January 2019 to December 2020 were collected.There were 43 males and 31 females.The age ranged from 68 to 74 years,with an average age of(69.82±5.73)years.There were 39 patients in the guided template CBT group,including 17 males and 22 females.The average age was(70.24±3.83)years(range 68 to 73 years).There were 35 patients in the manual CBT group,including 14 males and 21 females,aged 68 to 74 years,with an average age of(69.51±3.52)years.Gender,age,disease diagnosis,operation duration,blood loss(intraoperative and postoperative blood loss),intraoperative fluoroscopy times and screw location imaging evaluation were collected.The Oswestry disability index(ODI)and visual analogue scale(VAS)were used to evaluate the functional recovery of the patients preoperative,postoperative,and at follow-up at the end of one year.Postoperative complications such as wound infection,fusion device displacement,screw extraction and fixation rupture were compared between guided template CBT implantation and manual screw implantation.Results All patients were followed up for 12 to 30 months,with a mean of(20.92±8.57)months.There was a statistically significant difference in operation time between the guided template group and the freehand screw group(t=-23.20,P=0.03).The blood loss in guided template CBT group(80.00±12.65)mL was significantly lower than that(230.00±38.70)mL in manual CBT group(t=-36.62,P=0.03).The number of radiation-oriented CBT sessions during surgery was significantly lower than that in the hands-free group(3 VS 12 sessions,t=-5.65,P＜0.01).There were no significant differences in the incidence of wound infection and internal fixation failure between the guided template group and the free hand group(t=0.94,P=1.00).At the last follow-up,there was no significant difference in VAS score and ODI score between the two groups(t=-1.05,-0.79,P=0.28,P=0.36).Conclusion Guided template CBT implantation technique can shorten the operation time,reduce blood loss,and reduce radiation damage to patients and medical staff,so it is a more economical,efficient and effective CBT implantation technique.