Parr William C H, Burnard Joshua L, Wilson Peter John, Mobbs Ralph J
Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia.
3DMorphic Pty Ltd, Sydney, Australia.
J Spine Surg. 2019 Dec;5(4):549-560. doi: 10.21037/jss.2019.12.07.
The applications of three-dimensional printing (3DP) for clinical purposes have grown rapidly over the past decade. Recent advances include the fabrication of patient specific instrumentation, such as drill and cutting guides, patient specific/custom long term implants and 3DP of cellular scaffolds. Spine surgery in particular has seen enthusiastic early adoption of these applications. 3DP as a manufacturing method can be used to mass produce objects of the same design, but can also be used as a cost-effective method for manufacturing unique one-off objects, such as patient specific models and devices. Perhaps the first, and currently most widespread, application of 3DP for producing patient specific devices is the production of patient specific anatomical models, often termed biomodels. The present manuscript focuses on the current state of the art in anatomical (bio)models as used in spinal clinical practice. The biomodels shown and discussed include: translucent and coloured models to aid in identification of extent and margins of pathologies such as bone tumours; dynamic models for implant trial implantation and pre-operative sizing; models that can be disassembled to simulate surgical resection of diseased tissue and subsequent reconstruction. Biomodels can reduce risk to the patient by decreasing surgery time, reducing the probability of the surgical team encountering unexpected anatomy or relative positioning of structures and/or devices, and better pre-operative planning of the surgical workflow including ordered preparation of the necessary instrumentation for multi-step and revision procedures. Conversely, risks can be increased if biomodels are not accurate representations of the anatomy, which can occur if MRI/CT scan data is simply converted into 3DP format without interpretation of what the scan represents in terms of patient anatomy. A review and analysis of the cost-benefits of biomodels shows that biomodels can potentially reduce cost to health care providers if operating room time is reduced by 14 minutes or more.
在过去十年中，三维打印（3DP）在临床领域的应用迅速增长。最近的进展包括制造患者特异性器械，如钻孔和切割导向器、患者特异性/定制长期植入物以及细胞支架的3DP打印。特别是脊柱外科手术，对这些应用的早期采用热情高涨。3DP作为一种制造方法，可用于批量生产相同设计的物体，但也可作为一种经济有效的方法来制造独特的一次性物体，如患者特异性模型和器械。也许3DP用于生产患者特异性器械的首个且目前最广泛的应用是生产患者特异性解剖模型，通常称为生物模型。本手稿重点关注脊柱临床实践中使用的解剖（生物）模型的当前技术水平。展示和讨论的生物模型包括：半透明和彩色模型，以帮助识别骨肿瘤等病变的范围和边界；用于植入物试验植入和术前尺寸确定的动态模型；可拆解以模拟病变组织手术切除及后续重建的模型。生物模型可通过减少手术时间、降低手术团队遇到意外解剖结构或结构和/或器械相对位置的概率以及更好地进行手术工作流程的术前规划（包括为多步骤和翻修手术有序准备必要器械）来降低患者风险。相反，如果生物模型不能准确反映解剖结构，风险可能会增加，这种情况可能发生在MRI/CT扫描数据未经解释其在患者解剖结构方面的含义就简单转换为3DP格式时。对生物模型成本效益的回顾和分析表明，如果手术室时间减少14分钟或更多，生物模型有可能降低医疗服务提供者的成本。
