本文關鍵詞： -D打印技術 手術導板 骨腫瘤 修復重建　出處：《中國修復重建外科雜志》2014年03期 　論文類型：期刊論文

【摘要】：目的使用多種3-D打印技術制作手術導板,探討其在骨腫瘤切除重建手術中的應用效果,并對比不同3-D打印技術制備的手術導板優(yōu)缺點。方法回顧分析2012年9月-2014年1月符合選擇標準的31例骨腫瘤患者臨床資料,其中男19例,女12例;年齡6~67歲,中位年齡23歲。病程15 d~12個月,中位病程2個月。其中惡性腫瘤13例,良性腫瘤18例;腫瘤位于股骨9例、脊柱7例、脛骨6例、骨盆5例、肱骨3例、腓骨1例。根據(jù)術前薄層(0.625 mm)CT掃描等影像學檢查所得數(shù)據(jù)行術前腫瘤切除設計,根據(jù)切除計劃設計手術導板。術前加工導板使用的3-D打印技術和材料分別為:熔融沉積成型9例(ABS樹脂)、光固化立體成型14例(光敏樹脂)、3-D印刷工藝5例(石膏)、選擇性激光燒結3例(鋁合金);導板滅菌后按術前計劃應用于術中。通過對比導板制作加工時間分析4種3-D打印技術效率,記錄術前設計時間、手術時間、術中透視次數(shù),與同期同類常規(guī)手術28例(對照組)進行比較。結果 4種導板制作加工時間分別為:熔融沉積成型(19.3±6.5)h、光固化立體成型(5.2±1.3)h、3-D印刷工藝(8.6±1.9)h、選擇性激光燒結(51.7±12.9)h,選擇性激光燒結導板制作加工時間明顯長于另外3種。31例均成功進行術前設計、導板制作并應用于手術;除3例術中導板斷裂變形(ABS樹脂1例、石膏2例),改為常規(guī)手術治療外;余28例定位針均成功導入,根據(jù)定位針指引準確按術前手術設計截骨。與對照組比較,28例患者術前設計時間延長、手術時間縮短、術中透視次數(shù)減少,差異均有統(tǒng)計學意義(P0.05)。28例均獲隨訪,隨訪時間1~12個月,平均3.7個月。術后X線片及CT檢查示腫瘤均完整切除,大段同種異體骨重建穩(wěn)定。結論 3-D打印手術導板很好地適應了骨腫瘤手術個體化要求,可在術中實現(xiàn)術前設計,不同3-D打印技術制備的手術導板各有優(yōu)勢,需根據(jù)具體手術方式選擇。
[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 鹵6.5 hs, 5.2 鹵1.3 hh, 8.6 鹵1.9 hh, 51.7 鹵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.
【作者單位】： 第四軍醫(yī)大學西京骨科醫(yī)院骨腫瘤科;
【分類號】：TP334.8;R738.1

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