摘要
目的探讨个性化3D打印定位导板在颅内病变定位和切除术中的应用。方法选择厦门大学附属第一医院神经外科自2021年3月至5月收治的15例手术治疗的颅内占位性病变患者进入研究。所有患者均通过重建颅脑三维影像明确病变体表投影边界并设计、打印个性化定位导板。术前将定位导板贴合于患者皮肤,标记病变位置及边界,并通过神经导航进行定位评估,验证定位导板标记结果的准确性。术中根据显微镜下所见进行病变位置识别,术后复查颅脑CT和MRI评估病变切除效果。结果15例患者的个性化定位导板与皮肤贴合满意,皮肤切口和骨窗设计均满足手术要求,所有手术均一次性完成并成功切除病变组织,术中均未对皮肤切口进行二次扩切调整。术后48 h内复查患者颅脑MRI示11例肿瘤患者病变切除满意(9例全切除,2例次全切除),4例血肿患者术后12 h内复查颅脑CT提示3例血肿清除率为80%以上,1例血肿清除率为70%;所有患者均未出现脑脊液漏、颅内血肿、颅内感染等严重并发症。门诊、电话随访1~3个月,所有患者恢复良好。结论个性化3D打印导板定位方法简单便捷,定位结果准确,可以辅助临床医生更好地进行术前规划,优化手术切口设计,值得在基层医院中推广和应用。
Objective To explore the application value of individualized three-dimensional(3D)printing positioning guides in localization and resection of intracranial lesions.Methods Fifteen patients with intracranial space occupying lesions underwent resection in our hospital from March 2021 to May 2021 were selected in our study.Brain images by CT and MRI as raw data were used to design individual positioning guides.The positioning guides were placed on the patient's skin before resection to mark the location and boundary of the lesions with a marker,and neuro-navigation was used to verify the accuracy.During the resection,the location of the lesions was identified through microscope by the surgeons.Postoperative CT and MRI were used to evaluate the lesion resection.Results The individualized positioning guides of 15 patients fit the skin well,and the skin incision and bone window were designed to meet the surgical requirements.All surgeries were completed in one time,and the lesion tissues were successfully removed.During the surgeries,the skin incision was not adjusted for secondary expansion.Brain MRI reexamination within 48 h of surgery showed that the lesions of 11 patients with tumors were removed satisfactorily(total resection in 9 and subtotal resection in 2);brain CT reexamination within 12 h showed that the clearance rate of hematomas in 3 patients was above 80%and that in 1 patient was 70%.No patients had cerebrospinal fluid leakage,intracranial hematoma,intracranial infection or other serious complications.All patients recovered well during the 1-3 months of outpatient/telephone follow-up.Conclusion The positioning method with personalized 3D printing guides is simple and convenient,enjoying accurate positioning results,which can assist the clinicians to optimize the preoperative planning,optimize the surgical incision design,and is worthy of promotion and application in primary hospitals.
作者
师忠杰
高鑫
周立伟
王硕
郭剑锋
谭国伟
王占祥
Shi Zhongjie;Gao Xin;Zhou Liwei;Wang Shuo;Guo Jianfeng;Tan Guowei;Wang Zhanxiang(Department of Neurosurgery,First Affiliated Hospital of Xiamen University,Xiamen 361000,China)
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2021年第10期1039-1042,共4页
Chinese Journal of Neuromedicine
基金
国家自然科学基金(82072777)。
关键词
3D打印
定位导板
术前规划
Three-dimensional printing
Positioning guide
Preoperative planning
