Rocco Raffaele, Morris Jonathan, Wentworth Adam, Wigle Dennis, Reisenauer Janani
Division of Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
Department of Clinical Radiology, Mayo Clinic, Rochester, Minnesota.
Ann Thorac Surg Short Rep. 2023 Jul 12;1(4):713-717. doi: 10.1016/j.atssr.2023.06.005. eCollection 2023 Dec.
The minimally invasive Nuss procedure has emerged as the standard of care for correction of pectus excavatum. The site of chest wall insertion and bar shape are currently contoured on the basis of the surgeon's judgment. To optimize and individualize Nuss bar configuration, we aimed to create a virtual surgical planning workflow and 3-dimensional (3D) printed Nuss bar molds customized to each patient's defect.
Standard thin-section chest computed tomography images were imported into the planning software, and segmentation was used to extract anatomically relevant features including ribs, cartilage, sternum, and skin surface. Curves representing the ideal Nuss bar contour are splined on axial imaging. Molds designed from the Nuss bars are created within medical computer-aided design software and then 3D printed with a biocompatible sterilizable photosensitive resin, labeled with the correct orientation.
Virtual surgical planning and 3D reconstruction were used to create patient-specific sterilizable Nuss bar molds in 9 patients presenting with pectus excavatum. The Nuss bar was bent in the operating room to the optimized curve and fitted to the mold. Six male patients with a median age of 26 years underwent customized Nuss bar placement with no intraoperative complications and a procedural time of 126 minutes. The median length of stay was 4 days. No early postoperative revisions were required.
Although further prospective studies are warranted, this initial pilot demonstrates a replicable technique for virtual surgical planning workflows and patient-specific customizable Nuss bar molds for patients with pectus excavatum.
微创努斯手术已成为漏斗胸矫正的标准治疗方法。目前，胸壁插入部位和钢板形状是根据外科医生的判断来确定轮廓的。为了优化努斯钢板配置并实现个体化，我们旨在创建一个虚拟手术规划工作流程，并为每个患者的缺损定制三维（3D）打印的努斯钢板模具。
将标准的胸部薄层计算机断层扫描图像导入规划软件，利用分割技术提取包括肋骨、软骨、胸骨和皮肤表面等解剖学相关特征。在轴向成像上绘制代表理想努斯钢板轮廓的曲线。在医学计算机辅助设计软件中根据努斯钢板设计模具，然后用生物相容性可消毒的光敏树脂进行3D打印，并标注正确的方向。
利用虚拟手术规划和3D重建技术，为9例漏斗胸患者制作了个体化的可消毒努斯钢板模具。努斯钢板在手术室中弯成优化后的曲线并与模具适配。6例年龄中位数为26岁的男性患者接受了定制努斯钢板置入手术，术中无并发症，手术时间为126分钟。中位住院时间为4天。术后早期无需进行翻修。
尽管需要进一步的前瞻性研究，但这项初步试点研究展示了一种可复制的技术，用于漏斗胸患者的虚拟手术规划工作流程和个体化可定制的努斯钢板模具。
