Herath Buddhi, Laubach Markus, Suresh Sinduja, Schmutz Beat, Little J Paige, Yarlagadda Prasad K D V, Delbrück Heide, Hildebrand Frank, Hutmacher Dietmar W, Wille Marie-Luise
Australian Research Council Training Centre for Multiscale 3D Imaging, Modelling, and Manufacturing, Queensland University of Technology, Brisbane, Australia.
Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Australia.
Front Bioeng Biotechnol. 2024 Nov 19;12:1404481. doi: 10.3389/fbioe.2024.1404481. eCollection 2024.
A previously in-house developed patient-specific scaffold design workflow was extended with new features to overcome several limitations and to broaden its adaptability to diverse bone defects, thereby enhancing its fit for routine clinical use. It was applied to three clinical cases for further validation. A virtual surgical resection tool was developed to remove regions of the bone defect models. The minor cavity fill module enabled the generation of scaffold designs with smooth external surfaces and the segmental defect fill module allowed a versatile method to fill a segmental defect cavity. The boundary representation method based surgical approach module in the original workflow was redeveloped to use functional representation, eliminating previously seen resolution dependant artefacts. Lastly, a method to overlay the scaffold designs on computed tomography images of the defect for design verification by the surgeon was introduced. The extended workflow was applied to two ongoing clinical case studies of a complex bilateral femoral defect and a humerus defect, and also to a case of a large volume craniomaxillofacial defect. It was able to successfully generate scaffolds without any obstructions to their surgical insertion which was verified by digital examination as well as using physical 3D printed models. All produced surface meshes were free from 3D printing mesh errors. The scaffolds designed for the ongoing cases were 3D printed and successfully surgically implanted, providing confidence in the extended modular workflow's ability to be applied to a broad range of diverse clinical cases.
之前内部开发的患者特异性支架设计工作流程通过新功能进行了扩展，以克服若干限制并拓宽其对各种骨缺损的适应性，从而提高其适用于常规临床应用的程度。该流程应用于三个临床病例以进行进一步验证。开发了一种虚拟手术切除工具来去除骨缺损模型的区域。微小腔填充模块能够生成具有光滑外表面的支架设计，而节段性缺损填充模块提供了一种通用方法来填充节段性缺损腔。原始工作流程中基于边界表示法的手术方法模块被重新开发为使用功能表示法，消除了之前出现的分辨率相关伪影。最后，引入了一种将支架设计叠加在缺损的计算机断层扫描图像上以供外科医生进行设计验证的方法。扩展后的工作流程应用于两个正在进行的复杂双侧股骨缺损和肱骨缺损的临床病例研究，以及一个大体积颅颌面缺损病例。它能够成功生成支架，其手术植入没有任何阻碍，这通过数字检查以及使用物理3D打印模型得到了验证。所有生成的表面网格均无3D打印网格错误。为正在进行的病例设计的支架进行了3D打印并成功进行了手术植入，这为扩展的模块化工作流程应用于广泛多样的临床病例的能力提供了信心。
