Martinez-Ferro Marcelo, Bellia-Munzon Gaston, Toselli Luzia, Sanjurjo Daniela
Fundacion Hospitalaria Mother and Child Medical Center, Buenos Aires, Argentina.
Clinica Mi Pectus, Capital Federal, Buenos Aires, Argentina.
J Thorac Dis. 2024 Jun 30;16(6):4053-4063. doi: 10.21037/jtd-23-881. Epub 2024 Jun 24.
Technology is advancing fast, and chest wall surgery finds particular benefit in the broader availability of three-dimensional (3D) reconstruction and printing. An increasing number of reports are being published on the use of these resources in virtual 3D reconstructions of chest walls in computed tomography (CT) scans, virtual surgeries, 3D printing of real-size models for surgical planning, practice, and education, and of note, the manufacture of customized 3D printed implants, changing the fundamental conception from a surgery that fits all, to a surgery for each patient. In this review, we explore the evidence published on simple chest wall reconstruction, including the use of 3D technology to assist in the improvement of the repair of the most frequent chest wall deformities: pectus excavatum and carinatum. Current studies are oriented to the automatization and customization of transthoracic implants, as well as education on real-size models. Next, we investigate the implementation of 3D printing in the repair of complex chest wall reconstruction, comprised of infrequent chest wall deformities such as pectus arcuatum and Poland syndrome. These malformations are very heterogeneous resulting in a high degree of improvisation during the surgical repair. In this setting, 3D technology plays a role in the standardization of a process that contemplates customization, concepts that may seem contradictory. Finally, 3D printing with biocompatible materials is rapidly becoming the first choice for the reconstruction of wide chest wall oncological resections. In this work, we review the first and most important current publications on the subject.
技术进步日新月异，胸壁手术在三维（3D）重建和打印技术更广泛的应用中尤其受益。关于在计算机断层扫描（CT）中对胸壁进行虚拟3D重建、虚拟手术、为手术规划、实践和教育制作实物大小模型的3D打印，以及值得注意的定制3D打印植入物的使用等方面的报道越来越多，这将从一刀切的手术理念转变为针对每个患者的个性化手术。在本综述中，我们探讨了已发表的关于简单胸壁重建的证据，包括使用3D技术辅助改善最常见的胸壁畸形：漏斗胸和鸡胸的修复。当前的研究方向是经胸植入物的自动化和定制，以及实物大小模型的教学应用。接下来，我们研究3D打印在复杂胸壁重建修复中的应用，复杂胸壁重建包括罕见的胸壁畸形，如弓形胸和波兰综合征。这些畸形差异很大，导致手术修复过程中高度依赖临场发挥。在这种情况下，3D技术在兼顾定制化的过程标准化中发挥作用，而定制化和标准化这两个概念看似相互矛盾。最后，使用生物相容性材料的3D打印正迅速成为广泛胸壁肿瘤切除重建的首选。在这项工作中，我们回顾了该主题的首批也是最重要的当前出版物。
