个体化 3D 打印辅助修复和重建不规则骨部位的肿瘤性骨缺损：肩胛动脉瘤样骨囊肿治疗的探索与实践。
Individualized 3D printing-assisted repair and reconstruction of neoplastic bone defects at irregular bone sites: exploration and practice in the treatment of scapular aneurysmal bone cysts.
机构信息
Department of Bone and Soft Tissue Oncology, Affiliated Zhongshan Hospital of Dalian University, No. 6 Jiefang street, Dalian, 116001, Liaoning Province, China.
Dalian Economic and Technological Development Zone, Dalian University, No.10 Xuefu, Dajie, Liaoning, China.
出版信息
BMC Musculoskelet Disord. 2021 Nov 25;22(1):984. doi: 10.1186/s12891-021-04859-5.
BACKGROUND
The irregular anatomical shape and complex structures of irregular bones make it more difficult to repair and reconstruct bone defects in irregular bones than in the long bones of the extremities. Three-dimensional (3D) printing technology can help to overcome the technical limitations of irregular bone repair by generating simulations that enable structural integration of the lesion area and bone structure of the donor site in all directions and at multiple angles. Thus, personalized and accurate treatment plans for restoring anatomical structure, muscle attachment points, and maximal function can be made. The present study aimed to investigate the ability of 3D printing technology to assist in the repair and reconstruction of scapular aneurysmal ABC defects.
METHODS
The study included seven patients with ABCs of the scapula. Based on computed tomography (CT) data for the patient, the scapula (including the defect) and pelvis were reconstructed using Mimics Medical software. The reconstructed scapula model was printed using a 3D printer. Before the operation, the model was used to design the surgical approach and simulate the operation process, to determine the length and radius of the plate and the number and direction of screws, and to determine the bone mass of the ilium and develop reasonable strategies for segmentation and distribution. The operation time, amount of bleeding, length and radius of the plate, and direction and number of screws were recorded.
RESULTS
The average duration of follow-up was 25.6 months, and none of the seven patients experienced recurrence during the follow-up period. The surgical approach, the length and radius of internal fixation, and the number and direction of screws were consistent with the designed operation plan. Patients gradually recovered the anatomical structure of the scapula and function of the shoulder joint.
CONCLUSIONS
In the treatment of bone defects caused by irregular bone tumors, 3D printing technology combined with surgery has the advantages of less trauma, short operation time, less bleeding and reducing the difficulty of operation, which can reduce the waste of bone graft, and more complete reconstruction of the anatomical structure of the defective bone.
背景
不规则骨的解剖形状不规则且结构复杂，使得修复和重建不规则骨的骨缺损比修复四肢长骨的骨缺损更为困难。三维（3D）打印技术可以通过生成模拟来帮助克服不规则骨修复的技术限制，从而实现病变区域与供体部位骨结构在各个方向和多个角度的结构整合。因此，可以制定出个性化和精确的治疗计划，以恢复解剖结构、肌肉附着点和最大功能。本研究旨在探讨 3D 打印技术在肩胛骨动脉瘤性 ABC 缺损修复和重建中的应用能力。
方法
本研究纳入了 7 例肩胛骨 ABC 患者。基于患者的计算机断层扫描（CT）数据，使用 Mimics Medical 软件对肩胛骨（包括缺损部位）和骨盆进行了重建。使用 3D 打印机对重建的肩胛骨模型进行了打印。在手术前，使用模型设计手术入路并模拟手术过程，确定钢板的长度和半径、螺钉的数量和方向，以及确定髂骨的骨质，并制定合理的分割和分布策略。记录手术时间、出血量、钢板的长度和半径以及螺钉的方向和数量。
结果
平均随访时间为 25.6 个月，随访期间 7 例患者均无复发。手术入路、内固定的长度和半径以及螺钉的数量和方向均与设计的手术方案一致。患者逐渐恢复了肩胛骨的解剖结构和肩关节的功能。
结论
在治疗因不规则骨肿瘤引起的骨缺损时，3D 打印技术结合手术具有创伤小、手术时间短、出血量少、操作难度降低的优点，可以减少骨移植的浪费，更完整地重建缺损骨的解剖结构。
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