Palmquist Anders, Jolic Martina, Hryha Eduard, Shah Furqan A
Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Acta Biomater. 2023 Jan 15;156:125-145. doi: 10.1016/j.actbio.2022.06.002. Epub 2022 Jun 5.
The last decade has witnessed rapid advancements in manufacturing technologies for biomedical implants. Additive manufacturing (or 3D printing) has broken down major barriers in the way of producing complex 3D geometries. Electron beam melting (EBM) is one such 3D printing process applicable to metals and alloys. EBM offers build rates up to two orders of magnitude greater than comparable laser-based technologies and a high vacuum environment to prevent accumulation of trace elements. These features make EBM particularly advantageous for materials susceptible to spontaneous oxidation and nitrogen pick-up when exposed to air (e.g., titanium and titanium-based alloys). For skeletal reconstruction(s), anatomical mimickry and integrated macro-porous architecture to facilitate bone ingrowth are undoubtedly the key features of EBM manufactured implants. Using finite element modelling of physiological loading conditions, the design of a prosthesis may be further personalised. This review looks at the many unique clinical applications of EBM in skeletal repair and the ground-breaking innovations in prosthetic rehabilitation. From a simple acetabular cup to the fifth toe, from the hand-wrist complex to the shoulder, and from vertebral replacement to cranio-maxillofacial reconstruction, EBM has experienced it all. While sternocostal reconstructions might be rare, the repair of long bones using EBM manufactured implants is becoming exceedingly frequent. Despite the various merits, several challenges remain yet untackled. Nevertheless, with the capability to produce osseointegrating implants of any conceivable shape/size, and permissive of bone ingrowth and functional loading, EBM can pave the way for numerous fascinating and novel applications in skeletal repair, regeneration, and rehabilitation. STATEMENT OF SIGNIFICANCE: Electron beam melting (EBM) offers unparalleled possibilities in producing contaminant-free, complex and intricate geometries from alloys of biomedical interest, including Ti6Al4V and CoCr. We review the diverse range of clinical applications of EBM in skeletal repair, both as mass produced off-the-shelf implants and personalised, patient-specific prostheses. From replacing large volumes of disease-affected bone to complex, multi-material reconstructions, almost every part of the human skeleton has been replaced with an EBM manufactured analog to achieve macroscopic anatomical-mimickry. However, various questions regarding long-term performance of patient-specific implants remain unaddressed. Directions for further development include designing personalised implants and prostheses based on simulated loading conditions and accounting for trabecular bone microstructure with respect to physiological factors such as patient's age and disease status.
过去十年见证了生物医学植入物制造技术的快速发展。增材制造（或3D打印）打破了生产复杂3D几何形状的主要障碍。电子束熔炼（EBM）就是一种适用于金属和合金的3D打印工艺。EBM的构建速度比类似的基于激光的技术快两个数量级，并且提供高真空环境以防止微量元素的积累。这些特性使EBM对于暴露在空气中易发生自发氧化和氮吸收的材料（例如钛及钛基合金）特别有利。对于骨骼重建而言，解剖学模拟和促进骨长入的集成大孔结构无疑是EBM制造的植入物的关键特性。使用生理负荷条件的有限元建模，可以进一步使假体设计个性化。本文综述了EBM在骨骼修复中的众多独特临床应用以及假体康复方面的开创性创新。从简单的髋臼杯到第五趾，从手腕复合体到肩部，从椎体置换到颅颌面重建，EBM都经历过。虽然胸骨肋骨重建可能很少见，但使用EBM制造的植入物修复长骨正变得越来越频繁。尽管有各种优点，但仍有几个挑战尚未解决。然而，凭借能够生产任何可想象形状/尺寸的骨整合植入物，并允许骨长入和功能负荷的能力，EBM可以为骨骼修复、再生和康复中的众多引人入胜的新应用铺平道路。重要性声明：电子束熔炼（EBM）在由生物医学相关合金（包括Ti6Al4V和CoCr）生产无污染物、复杂且精细的几何形状方面提供了无与伦比的可能性。我们综述了EBM在骨骼修复中的各种临床应用，包括作为批量生产的现成植入物和个性化的、针对患者的假体。从替换大量患病骨骼到复杂的多材料重建，人体骨骼的几乎每个部位都已被EBM制造的类似物所取代，以实现宏观解剖学模拟。然而，关于针对患者的植入物的长期性能的各种问题仍未得到解决。进一步发展的方向包括基于模拟负荷条件设计个性化植入物和假体，并考虑与患者年龄和疾病状态等生理因素相关的小梁骨微观结构。
