Bray Jonathan P, Kersley Andrew, Downing Warwick, Crosse Katherine R, Worth Andrew J, House Arthur K, Yates Guy, Coomer Alastair R, Brown Ian W M
J Am Vet Med Assoc. 2017 Sep 1;251(5):566-579. doi: 10.2460/javma.251.5.566.
OBJECTIVE To characterize the processes involved in and outcomes achieved with custom-designed patient-specific implants to provide functional replacement of skeletal structures in dogs with tumors of the mandible, radius, or tibia. DESIGN Prospective case series. ANIMALS 6 dogs with mandibular tumors, 5 with tumors of the distal aspect of the radius, and 1 with a tumor in the distal aspect of the tibia treated from June 2013 to September 2016 at 3 referral centers. PROCEDURES After tumor staging, implants were designed from patients' CT scans by means of various computer-aided design applications and printed by means of selective laser melting in titanium-6 aluminum-4 vanadium alloy. A cutting jig was created in thermoplastic to ensure each osteotomy was performed as planned. Following ostectomy, the implant was secured into the defect with screws of appropriate size and length. RESULTS Initial return to normal clinical function was good to excellent for 11 of the 12 dogs. However, major complications resulted in revision of the implant or amputation of the limb in 5 dogs, and at least 3 of these complications were considered a consequence of faulty implant design or manufacturing. Infection developed in 2 dogs and was successfully treated in 1 dog. The longest-surviving dog maintained good limb function for 2 years. CONCLUSIONS AND CLINICAL RELEVANCE This is the largest reported series of dogs managed with customized 3-D-printed titanium implants. The 3-D printing allowed complex and patient-specific 3-D geometries to be fabricated, enabling function-sparing treatment of bone cancer affecting multiple anatomic sites.
目的 描述定制的患者特异性植入物所涉及的过程及取得的结果，以功能性替代患有下颌骨、桡骨或胫骨肿瘤的犬的骨骼结构。 设计 前瞻性病例系列。 动物 2013年6月至2016年9月在3个转诊中心接受治疗的6只患有下颌骨肿瘤的犬、5只患有桡骨远端肿瘤的犬和1只患有胫骨远端肿瘤的犬。 程序 在肿瘤分期后，通过各种计算机辅助设计应用程序根据患者的CT扫描设计植入物，并通过选择性激光熔化以钛-6铝-4钒合金打印。用热塑性塑料制作一个切割夹具，以确保每次截骨术按计划进行。截骨术后，用尺寸和长度合适的螺钉将植入物固定到缺损处。 结果 12只犬中有11只最初恢复到正常临床功能的情况良好至极佳。然而，严重并发症导致5只犬的植入物需要翻修或肢体截肢，其中至少3种并发症被认为是植入物设计或制造缺陷的结果。2只犬发生感染，1只犬成功治愈。存活时间最长的犬保持良好的肢体功能达2年。 结论及临床意义 这是报道的最大系列使用定制的三维打印钛植入物治疗的犬。三维打印能够制造复杂的、患者特异性的三维几何形状，从而能够对影响多个解剖部位的骨癌进行保留功能的治疗。
