Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
Thoracic Surgery Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
Ann Thorac Surg. 2022 Sep;114(3):979-988. doi: 10.1016/j.athoracsur.2021.07.103. Epub 2021 Sep 21.
Tumors involving the chest wall may require extensive resection and reconstruction. This study aims to evaluate functional, cosmetic results, and quality of life (QoL) in patients who had a reconstruction based on patient-specific 3-dimensional (3D) printing.
The patient-specific chest wall prosthesis was created for 10 patients. The anatomical models were 3D printed and used to produce a silicone mold that was filled with methyl methacrylate to create the customized prosthesis. Evaluation of the reconstruction was completed with a QoL assessment and postoperative tracking of patients' chest motion, using infrared markers. The distance between plot points representing markers on the operated and contralateral sides was measured to assess symmetrical motion.
Twenty-three consecutive patients were enrolled, with the median age of 64 years. Thirteen patients underwent a nonrigid reconstruction, and 10 had a patient-specific rigid reconstruction with methyl methacrylate. The median number of ribs resected was 3. No postoperative complications or morbidity related to the prostheses were reported. The median hospital stay in the nonrigid reconstruction group was 8.5 days compared with 7.5 days (p = .167) in the rigid reconstruction group. Postoperatively, most patients had low levels of symptoms, with 82% experiencing chest pain and 53% experiencing dyspnea. Rigid reconstruction patients demonstrated more symmetrical breathing motion compared with nonrigid reconstruction patients. The mean distances were 2.32 ± 2.18 and 7.28 ± 5.87 (P < .00001), respectively.
This study shows that a 3D patient-specific prosthesis is feasible and safe, suggesting a possible trend toward improved breathing mechanics, QoL, and cosmetic results.
涉及胸壁的肿瘤可能需要广泛的切除和重建。本研究旨在评估基于患者特定的三维（3D）打印进行重建的患者的功能、美容效果和生活质量（QoL）。
为 10 名患者创建了患者特定的胸壁假体。使用 3D 打印制作解剖模型，并使用该模型制作硅胶模具，然后将其填充甲基丙烯酸甲酯以创建定制假体。使用 QoL 评估和术后跟踪患者的胸部运动，使用红外标记来完成重建的评估。测量代表手术侧和对侧标记的绘图点之间的距离，以评估对称运动。
连续纳入了 23 名患者，中位年龄为 64 岁。13 名患者接受了非刚性重建，10 名患者接受了甲基丙烯酸甲酯的患者特定刚性重建。切除的肋骨中位数为 3 根。未报告与假体相关的术后并发症或发病率。非刚性重建组的中位住院时间为 8.5 天，刚性重建组为 7.5 天（p=.167）。术后，大多数患者的症状水平较低，82%的患者有胸痛，53%的患者有呼吸困难。刚性重建患者的呼吸运动比非刚性重建患者更对称。平均距离分别为 2.32±2.18 和 7.28±5.87（P<.00001）。
本研究表明，3D 患者特定假体是可行且安全的，这表明呼吸力学、QoL 和美容效果可能有所改善。
