Vivarelli Leonardo, Govoni Marco, Attala Dario, Zoccali Carmine, Biagini Roberto, Dallari Dante
Reconstructive Orthopaedic Surgery and Innovative Techniques-Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy.
Department of Oncological Orthopaedics-Musculoskeletal Tissue Bank, IRCCS-Regina Elena National Cancer Institute, 00144 Rome, Italy.
J Clin Med. 2022 May 15;11(10):2781. doi: 10.3390/jcm11102781.
The use of massive bone allografts after the resection of bone tumours is still a challenging process. However, to overcome some issues related to the processing procedures and guarantee the best three-dimensional matching between donor and recipient, some tissue banks have developed a virtual tissue database based on the scanning of the available allografts for using their 3D shape during virtual surgical planning (VSP) procedures. To promote the use of future VSP bone-shaping protocols useful for machining applications within a cleanroom environment, in our work, we simulate a massive bone allograft machining with two different machines: a four-axes (computer numerical control, CNC) vs. a five-axes (robot) milling machine. The allograft design was based on a real case of allograft reconstruction after pelvic tumour resection and obtained with 3D Slicer and Rhinoceros software. Machining simulations were performed with RhinoCAM and graphically and mathematically analysed with CloudCompare and R, respectively. In this case, the geometrical differences of the allograft design are not clinically relevant; however, the mathematical analysis showed that the robot performed better than the four-axes machine. The proof-of-concept presented here paves the way towards massive bone allograft cleanroom machining. Nevertheless, further studies, such as the simulation of different types of allografts and real machining on massive bone allografts, are needed.
骨肿瘤切除后使用大块骨移植仍然是一个具有挑战性的过程。然而，为了克服与处理程序相关的一些问题，并确保供体和受体之间实现最佳的三维匹配，一些组织库基于对可用同种异体骨的扫描开发了虚拟组织数据库，以便在虚拟手术规划（VSP）程序中使用其三维形状。为了推动未来适用于洁净室环境中加工应用的VSP骨塑形方案的使用，在我们的工作中，我们用两种不同的机器模拟了大块骨移植加工：一台四轴（计算机数控，CNC）铣床与一台五轴（机器人）铣床。同种异体骨设计基于骨盆肿瘤切除后同种异体骨重建的一个真实病例，并通过3D Slicer和Rhinoceros软件获得。加工模拟使用RhinoCAM进行，分别通过CloudCompare和R进行图形和数学分析。在这种情况下，同种异体骨设计的几何差异在临床上并不相关；然而，数学分析表明机器人的表现优于四轴机器。此处展示的概念验证为大块骨移植洁净室加工铺平了道路。尽管如此，仍需要进一步的研究，例如对不同类型同种异体骨的模拟以及对大块骨移植进行实际加工。
