目的：探究 3D 打印结合椎弓根螺钉双皮质固定治疗腰椎不稳症合并骨质疏松的临床效果。方法：选取 2019 年 5 月— 2020 年 5 月本院收治的 96 例腰椎不稳症合并骨质疏松患者，采用随机数字表法将其分为研究组（n=48）和对照组（n=48）。 两组患者均采用椎弓根螺钉双皮质固定治疗，对照组于 X 线辅助下行手术治疗，研究组结合 3D 打印技术行手术治疗。比较 两组手术情况、住院时间、并发症发生率、腰椎功能优良率、植骨融合率、手术前后影像学复位情况（伤椎高度、伤椎前缘 高度压缩比、Cobb 角）、炎性 - 应激因子 [CRP、TNF-α、P 物质（SP）、前列腺素 E2（PGE2）]、疼痛程度（VAS 评分）、 腰椎功能（ODI 评分）。结果：相较于对照组，研究组手术时间、住院时间和术中出血量明显下降（P<0.05），而置钉准确 率显著升高（P<0.05）；3D 打印技术模拟的伤椎高度、伤椎前缘压缩比、Cobb 角与实际值的差异无统计学意义（P>0.05）； 相较于术前，两组患者术后即刻伤椎高度明显升高（P<0.05），而伤椎前缘高度压缩比、Cobb 角显著下降（P<0.05），且研 究组改善情况明显优于对照组（P<0.05）；两组患者术后的炎症因子均升高，但是研究组患者各时间点的升高趋势均明显低 于对照组（P<0.05）；两组患者术后 1 个月、6 个月、12 个月 VAS、ODI 评分均低于术前，且研究组患者术后 1 个月评分改 善情况优于对照组（P<0.05），两组患者术后 6 个月、12 个月 VAS、ODI 评分比较，差异无统计学意义（P>0.05）；研究组 患者术后 12 个月腰椎功能优良率、植骨融合率与对照组比较，差异无统计学意义（P>0.05）；研究组患者术后并发症发生 率与对照组比较，差异无统计学意义（P>0.05）。结论：3D 打印结合椎弓根螺钉双皮质固定治疗腰椎不稳症合并骨质疏松 患者的临床效果好、并发症少，能更有效降低手术创伤引起的炎症、应激反应，具有较高的推广和应用价值。

Objective: To explore the clinical effect of 3D printing combined with pedicle screw bicortical fixation in the treatment of lumbar spine instability with osteoporosis. Methods: 96 patients with lumbar spine instability combined with osteoporosis who were treated in the Sixth Affiliated Hospital of Jinan University from May 2019 to May 2020 were selected. They were divided into the study group (n=48) and the control group (n=48) using a random number table. Both groups were treated with pedicle screw bicortical fixation, while the control group was treated under the assistance of X-ray, and the study group was assisted with 3D printing technology. The operative conditions, length of hospital stay, incidence rate of complications, good and excellent rate of lumbar spine function, bone graft fusion rate, imaging reduction before and after operation (injured vertebra height, anterior edge height compression ratio, Cobb angle), inflammatory- stress factors [C reactive protein (CRP), tumor necrosis factor-α (TNF-α), substance P (SP), prostaglandin E2 (PGE2)], VAS score, Oswestry Disability Index (ODI) of patients in the two groups were compared. Results: Compared with the control group, the study group showed a significant decrease in operative time, length of hospital stay, and intraoperative bleeding (P<0.05), while the accuracy of nail placement was significantly increased (P<0.05). There was no statistically significant difference in the simulated height of the injured vertebra, compression ratio of the anterior edge of the injured vertebra, and Cobb angle between 3D printing and the actual values (P>0.05). Compared to that before surgery, the height of the injured vertebrae in the two groups immediately after surgery was significantly increased (P<0.05), while the compression ratio of the anterior edge height of the injured vertebrae and Cobb angle were significantly reduced (P<0.05), and the improvement of patients in the study group was significantly better than that in the control group (P<0.05). The inflammatory factors in the two groups of patients increased after surgery, but the increasing trend of the study group was significantly lower than that in the control group at different timepoints (P<0.05). The VAS and ODI scores of patients in the two groups at 1 month, 6 months, and 12 months after operation were lower than those before operation, and the improvement in the scores of the study group at 1 month after surgery was better than that of the control group (P<0.05). There was no statistically significant difference in VAS and ODI scores at 6 months and 12 months after operation (P>0.05). The difference in the good and excellent rate of lumbar spine function and bone graft fusion rate at 12 months after operation between the two groups of patients was not statistically significant (P>0.05), and there was no statistically significant difference in incidence rate of postoperative complications between the two groups of patients (P>0.05). Conclusion: 3D printing combined with pedicle screw bicortical fixation has a good clinical effect and fewer complications in the treatment of patients with lumbar spine instability and osteoporosis, it could more effectively reduce the inflammation and stress response caused by surgical trauma, which is of high promotion and application value.

基金项目：东莞市社会科技发展项目（201950715001274）

Foundation Item: Social Science and Technology Development Project of Dongguan City (201950715001274) 

引用格式：张史飞，温干军，周植森，等 . 3D 打印结合椎弓根螺钉双皮质固定治疗合并骨质疏松的腰椎不稳症的临床研究 [J]. 机器人外科 学杂志（中英文），2025，6（3）：355-361. 

Citation: ZHANG S F, WEN G J, ZHOU Z S, et al. Clinical study of 3D printing combined with pedicle screw bicortical fixation in the  treatment of lumbar spine instability with osteoporosis [J]. Chinese Journal of Robotic Surgery, 2025, 6(3): 355-361. 

通讯作者（Corresponding Author）：张史飞（ZHANG Shifei），Email：thooshe23772@21cn.com

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