多种3-D打印手术导板在骨肿瘤切除重建手术中的应用

发布时间：2018-02-13 03:14

本文关键词： -D打印技术手术导板骨肿瘤修复重建　出处：《中国修复重建外科杂志》2014年03期 　论文类型：期刊论文

【摘要】：目的使用多种3-D打印技术制作手术导板,探讨其在骨肿瘤切除重建手术中的应用效果,并对比不同3-D打印技术制备的手术导板优缺点。方法回顾分析2012年9月-2014年1月符合选择标准的31例骨肿瘤患者临床资料,其中男19例,女12例;年龄6~67岁,中位年龄23岁。病程15 d~12个月,中位病程2个月。其中恶性肿瘤13例,良性肿瘤18例;肿瘤位于股骨9例、脊柱7例、胫骨6例、骨盆5例、肱骨3例、腓骨1例。根据术前薄层(0.625 mm)CT扫描等影像学检查所得数据行术前肿瘤切除设计,根据切除计划设计手术导板。术前加工导板使用的3-D打印技术和材料分别为:熔融沉积成型9例(ABS树脂)、光固化立体成型14例(光敏树脂)、3-D印刷工艺5例(石膏)、选择性激光烧结3例(铝合金);导板灭菌后按术前计划应用于术中。通过对比导板制作加工时间分析4种3-D打印技术效率,记录术前设计时间、手术时间、术中透视次数,与同期同类常规手术28例(对照组)进行比较。结果 4种导板制作加工时间分别为:熔融沉积成型(19.3±6.5)h、光固化立体成型(5.2±1.3)h、3-D印刷工艺(8.6±1.9)h、选择性激光烧结(51.7±12.9)h,选择性激光烧结导板制作加工时间明显长于另外3种。31例均成功进行术前设计、导板制作并应用于手术;除3例术中导板断裂变形(ABS树脂1例、石膏2例),改为常规手术治疗外;余28例定位针均成功导入,根据定位针指引准确按术前手术设计截骨。与对照组比较,28例患者术前设计时间延长、手术时间缩短、术中透视次数减少,差异均有统计学意义(P0.05)。28例均获随访,随访时间1~12个月,平均3.7个月。术后X线片及CT检查示肿瘤均完整切除,大段同种异体骨重建稳定。结论 3-D打印手术导板很好地适应了骨肿瘤手术个体化要求,可在术中实现术前设计,不同3-D打印技术制备的手术导板各有优势,需根据具体手术方式选择。
[Abstract]:Objective to study the effect of using various 3-D printing techniques to make surgical guide plate in bone tumor resection and reconstruction. Methods from September 2012 to January 2014, 31 patients with bone tumor, including 19 males and 12 females, aged 6 to 67 years, were analyzed retrospectively. The median age was 23 years. The course of disease ranged from 15 days to 12 months, and the median course was 2 months. Among them, 13 cases were malignant tumors, 18 cases were benign tumors, 9 cases were located in femur, 7 cases in spine, 6 cases in tibia, 5 cases in pelvis, 3 cases in humerus. One case of fibula. According to the imaging data of preoperative thin-layer scan and 0.625 mm)CT scan, the preoperative tumor resection design was carried out. According to the plan of excision, the surgical guide plate was designed. The 3-D printing technique and materials used in the pre-operation processing of the guide plate were as follows: 9 cases of melt deposition molding and 14 cases of photosolidification stereoscopic molding (Guang Min resin / 3-D printing process 5 cases (gypsum)). Selective laser sintering was performed in 3 cases (aluminum alloy); the guide plate was sterilized and applied to the operation according to the pre-operation plan. The efficiency of four 3-D printing techniques was analyzed by comparing the processing time of the guide plate making, and analyzing the efficiency of the four kinds of 3-D printing technology. The design time, operation time and times of fluoroscopy were recorded. Results the processing time of four kinds of guide plates were 19.3 卤6.5 hs, 5.2 卤1.3 hh, 8.6 卤1.9 hh, 51.7 卤12.9 hh, respectively. The fabrication time of optical sintered guide plate was obviously longer than that of other 3 kinds. 31 cases were successfully designed before operation. The guide plate was made and applied to the operation, except for 3 cases of fracture and deformation of the guide plate, 1 case of ABS resin, 2 cases of gypsum, and 2 cases of plaster, the other 28 cases were successfully introduced into the needle. In comparison with the control group, the preoperative design time was prolonged, the operative time was shortened, the times of fluoroscopy were decreased, and the difference was statistically significant (P 0.05). 28 cases were followed up, according to the guidance of the positioning needle, and compared with the control group, the preoperative design time was prolonged, the operative time was shortened, and the times of fluoroscopy were decreased. The follow-up time ranged from 1 to 12 months (mean 3.7 months). X-ray and CT examinations showed that the tumor was resected completely and the large segment of allograft was stable. Conclusion the 3-D printing guide plate is very suitable for the individualization of bone tumor surgery. The preoperative design can be realized during the operation, and different 3-D printing techniques have their own advantages, which need to be selected according to the specific operation mode.
【作者单位】：第四军医大学西京骨科医院骨肿瘤科;
【分类号】：TP334.8;R738.1

【相似文献】