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(P<0.05)。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。
Objective To explore the effectiveness of excision and reconstruction of bone tumor by using operation guide plate made by variety of three-dimensional （3-D） printing techniques, and to compare the advantages and disadvantages of different 3-D printing techniques in the manufacture and application of operation guide plate. Methods Between September 2012 and January 2014, 31 patients with bone tumor underwent excision and reconstruction of bone tumor by using operation guide plate. There were 19 males and 12 females, aged 6-67 years （median, 23 years）. The disease duration ranged from 15 days to 12 months （median, 2 months）. There were 13 cases of malignant tumor and 18 cases of benign tumor. The tumor located in the femur （9 cases）, the spine （7 cases）, the tibia （6 cases）, the pelvis （5 cases）, the humerus （3 cases）, and the fibula （1 case）. Four kinds of 3-D printing technique were used in processing operation guide plate： fused deposition modeling （FDM） in 9 cases, stereo lithography appearance （SLA） in 14 cases, 3-D printing technique in 5 cases, and selective laser sintering （SLS） in 3 cases; the materials included ABS resin, photosensitive resin, plaster, and aluminum alloy, respectively. Before operation, all patients underwent thin layer CT scanning （0.625 mm） in addition to conventional imaging. The data were collected for tumor resection design, and operation guide plate was designed on the basis of excision plan. Preoperatively, the operation guide plates were made by 3-D printing equipment. After sterilization, the guide plates were used for excision and reconstruction of bone tumor. The time of plates processing cycle was recorded to analyse the efficiency of 4 kinds of 3-D printing techniques. The time for design and operation and intraoperative fluoroscopy frequency were recorded. Twenty-eight patients underwent similar operations during the same period as the control group. Results The processing time of operation guide plate was （19.3 ± 6.5） hours in FDM, （5.2 ± 1.3） hours in SLA, （8.6 ± 1.9） hours in 3-D printing technique, and （51.7 ± 12.9） hours in SLS. The preoperative design and operation guide plate were successfully made, which was used for excision and reconstruction of bone tumor in 31 cases. Except 3 failures （operation guide plate fracture）, the resection and reconstruction operations followed the preoperative design in the other 28 cases. The patients had longer design time, shorter operation time, and less fluoroscopy frequency than the patients of the control group, showing significant differences （P 〈 0.05）. The follow-up time was 1-12 months （mean, 3.7 months）. Postoperative X-ray and CT showed complete tumor resection and stable reconstruction. Conclusion 3-D printing operation guide plates are well adapted to the requirements of individual operation for bone tumor resection and reconstruction. The 4 kinds of 3-D printing techniques have their own advantages and should be chosen according to the need of operation.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2014年第3期304-308,共5页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
3-D打印技术
手术导板
骨肿瘤
修复重建
Three-dimensional printing technique
Operation guide plate
Bone tumor
Repair andreconstruction
