摘要
目的探讨数字化骨科技术在脊柱肿瘤手术设计中的指导意义以及3D打印人工椎体临床初步应用效果。方法回顾性分析2018年6月至2019年6月南方医科大学深圳医院骨科中心将3D打印人工椎体植入2例脊柱肿瘤患者的临床资料。男,32岁,颈椎神经鞘瘤;女,27岁,腰椎骨巨细胞瘤。通过Mimics软件三维重建肿瘤及周围解剖关系,规划手术设计,模拟截骨范围,3D打印疾病模型及手术导板,并个体化设计相匹配的金属人工椎体,包括钛合金椎体直径、孔隙率及重建固定方式。按照术前计划完成病灶切除和假体植入脊柱完成重建。术后定期观察患者颈或腰椎活动功能、肿瘤复发情况及脊柱重建稳定性。结果2例患者均顺利按计划完成手术,分别获得21、13个月随访,术后影像学资料显示3D打印人工椎体与周围椎体匹配良好,重建稳定未见松动及周围骨溶解,肿瘤切除完整未复发,颈、腰椎活动良好。结论数字化骨科技术在脊柱肿瘤治疗中可给予精准化指导,3D打印金属人工椎体设计需结合局部生理解剖个性化设计,其临床应用为脊柱肿瘤切除和脊柱重建提供了一种新方案。
Objective To explore the significance of digital orthopedic technology in surgical plan for spinal tumor and the preliminary outcomes of 3D printed vertebral bodies in spinal tumor surgery.Methods The clinical data of 2 patients were retrospectively analyzed who had had a 3D printed vertebral body implanted at Center of Orthopaedics,Shenzhen Hospital from June 2018 to December 2019.One was a 32-year-old male,diagnosed with cervical neurinoma;the other was a 27-year-old female,diagnosed with giant cell tumor of lumbar bone.3D virtual reconstruction of tumor and surrounding structures was established via Mimics software for surgical plan.Virtual osteotomy was simulated,their disease models and guide templates were 3D printed,and their metal artificial vertebral bodies were 3D printed after personalized design of the vertebral body diameter,porosity and procedures of reconstruction and fixation.Lesion resection and prosthesis implantation were carried out in accordance with the preoperative plan.After operation,the motor function of cervical or lumbar vertebrae,tumor recurrence,and spinal stability reconstructed were regularly observed.Results Resections and reconstructions went uneventfully in both cases.The 2 patients were followed up for 21 and 13 months respectively.Their postoperative images showed that their 3D printed vertebral bodies fitted the neighboring vertebral bodies well.The spinal stability was reconstructed without any loosening or periprosthetic osteolysis,and the tumors were removed completely with no recurrence in both cases.Their spinal motor function was satisfactory.Conclusions Digital orthopedic technology can offer accurate guidance in the treatment of spinal tumors.It is necessary to consider local physiological anatomy in personalized design of a metal vertebral body 3D printed.Clinical application of 3D printed metal vertebral bodies is a new strategy for spinal reconstruction following spinal tumor resection.
作者
吴家昌
李修往
方国芳
庄伟达
周震全
崔文岗
林云志
裴国献
桑宏勋
Wu Jiachang;Li Xiuwang;Fang Guofang;Zhuang Weida;Zhou Zhenquan;Cui Wengang;Lin Yunzhi;Pei Guoxian;Sang Hongxun(Center of Orthopaedics,Shenzhen Hospital,Southern Medical University,Shenzhen 518110,China;Hospital Affiliated to Southern University of Science and Technology,Shenzhen 518055,China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2020年第10期855-861,共7页
Chinese Journal of Orthopaedic Trauma
基金
国家自然科学基金面上项目(81871767)
深圳市医疗卫生"三名工程"高层次医学团队(SZSM201612019)
深圳市数字外科3D打印重点实验室(ZDSYS201707311542415)
南方医科大学临床研究启动项目(LC2016ZD036)
南方医科大学深圳医院苗苗培育计划(2018MM13)。
关键词
脊柱
肿瘤
假体设计
3D打印技术
人工椎体
Spine
Neoplasms
Prosthesis design
3D printing technology
Artificial vertebral body
