Pontiki Antonia A, Lampridis Savvas, De Angelis Sara, Lamata Pablo, Housden Richard, Benedetti Giulia, Bille Andrea, Rhode Kawal
Department of Surgical & Interventional Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
Department of Thoracic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
Front Surg. 2022 Aug 15;9:936638. doi: 10.3389/fsurg.2022.936638. eCollection 2022.
Management of chest wall defects after oncologic resection can be challenging, depending on the size and location of the defect, as well as the method of reconstruction. This report presents the first clinical case where patient-specific rib prostheses were created using a computer program and statistical shape model of human ribs. A 64-year-old male was diagnosed with non-small-cell lung cancer originating in the right upper lobe and invading the lateral aspect of the 3rd, 4th, and 5th ribs. Prior to surgical resection, a statistical shape model of human ribs was created and used to synthesise rib models in the software MATLAB (MathWorks, Natick, MA, USA). The patient's age, weight, height, and sex, as well as the number and side of the ribs of interest, were the inputs to the program. Based on these data, the program generated digital models of the right 3rd, 4th, and 5th ribs. These models were 3D printed, and a silicone mould was created from them. The patient subsequently underwent right upper lobectomy with resection of the involved chest wall. During the operation, the silicone mould was used to produce rigid prostheses consisting of methyl methacrylate and two layers of polypropylene mesh in a "sandwich" fashion. The prosthetic patch was then implanted to cover the chest wall defect. Thirty days after the surgery, the patient has returned to his pre-disease performance and physical activities. The statistical shape model and 3D printing is an optimised 3D modelling method that can provide clinicians with a time-efficient technique to create personalised rib prostheses, without any expertise or prior software knowledge.
肿瘤切除术后胸壁缺损的处理可能具有挑战性，这取决于缺损的大小和位置以及重建方法。本报告介绍了首例使用计算机程序和人类肋骨统计形状模型制作患者特异性肋骨假体的临床病例。一名64岁男性被诊断为起源于右上叶并侵犯第3、4和5肋骨外侧的非小细胞肺癌。在手术切除前，创建了人类肋骨的统计形状模型，并用于在MATLAB软件（美国马萨诸塞州纳蒂克市MathWorks公司）中合成肋骨模型。患者的年龄、体重、身高和性别，以及感兴趣的肋骨数量和侧别，是该程序的输入信息。基于这些数据，该程序生成了右侧第3、4和5肋骨的数字模型。这些模型被3D打印出来，并由此制作了一个硅胶模具。患者随后接受了右上叶切除术及受累胸壁切除术。手术过程中，使用硅胶模具制作了由甲基丙烯酸甲酯和两层聚丙烯网以“三明治”方式组成的刚性假体。然后植入假体补片以覆盖胸壁缺损。手术后30天，患者已恢复到患病前的活动能力和身体活动水平。统计形状模型和3D打印是一种优化的3D建模方法，可为临床医生提供一种高效的技术来制作个性化肋骨假体，而无需任何专业知识或先前的软件知识。
