CAJ | 학술논문

目的设计数字化结合3D打印个体化导板并应用于骨肿瘤切除重建手术,探讨导板及其设计对手术操作的影响. 方法选取2012年9月至2014年8月期间适合使用手术导板的35例骨肿瘤患者,男21岁,女14岁;年龄6 ～ 67岁,平均22.7岁.恶性肿瘤14例,良性肿瘤21例.通过计算机完成个体化的手术和导板设计,同时采用3D打印技术进行打印.加工使用的3D打印设备分别包括:熔融沉积造型、光固化立体造型、三维印刷工艺以及选择性激光烧结,材料包括:ABS树脂、光敏树脂、石膏、铝合金.术前完成导板的加工、清洗、低温消毒后,按术前计划应用于术中,术后摄患处X线片或CT扫描验证肿瘤切除及重建情况. 结果 35例患者均顺利完成术前个体化设计和3D打印手术操作.其中采用光敏树脂17例,ABS树脂10例,石膏5例,铝合金3例;导板经骨面31例,经皮肤4例.除3例术中导板断裂患者使用常规方式手术外,其余患者均按术前设计完成肿瘤切除及重建手术,术后X线片或CT均显示肿瘤完整切除,重建位置良好. 结论数字化结合3D打印个体化导板能够适应骨肿瘤手术的个体化需求,在手术中能够准确还原术前设计;不同3D打印技术加工的导板各具特点,需要在术前设计阶段根据术式、加工方式等不同调整导板设计方案.
목적 설계수자화결합3D타인개체화도판병응용우골종류절제중건수술,탐토도판급기설계대수술조작적영향. 방법 선취2012년9월지2014년8월기간괄합사용수술도판적35례골종류환자,남21세,녀14세;년령6 ～ 67세,평균22.7세.악성종류14례,량성종류21례.통과계산궤완성개체화적수술화도판설계,동시채용3D타인기술진행타인.가공사용적3D타인설비분별포괄:용융침적조형、광고화입체조형、삼유인쇄공예이급선택성격광소결,재료포괄:ABS수지、광민수지、석고、려합금.술전완성도판적가공、청세、저온소독후,안술전계화응용우술중,술후섭환처X선편혹CT소묘험증종류절제급중건정황. 결과 35례환자균순리완성술전개체화설계화3D타인수술조작.기중채용광민수지17례,ABS수지10례,석고5례,려합금3례;도판경골면31례,경피부4례.제3례술중도판단렬환자사용상규방식수술외,기여환자균안술전설계완성종류절제급중건수술,술후X선편혹CT균현시종류완정절제,중건위치량호. 결론 수자화결합3D타인개체화도판능구괄응골종류수술적개체화수구,재수술중능구준학환원술전설계;불동3D타인기술가공적도판각구특점,수요재술전설계계단근거술식、가공방식등불동조정도판설계방안.
Objective To report design and application of a guide plate manufactured by digital and 3D printing technology for excision and reconstruction of bone tumor.Methods From 2012 September to 2014 August,35 patients with bone tumor were chosen to use guide plate in bone tumor surgery at our department.They were 21 males and 14 females,aged from 6 to 67 years old (average,22.7 years).The tumor was malignant in 14 cases and benign in 21 cases.Before operation,all patients underwent thin layer CT scanning in addition to conventional imaging.The data were collected for design of individualized tumor excision and the customized guide plate was designed on the basis of excision plan.The 3D printing technology included fused deposition modeling,stereo lithography appearance,3D printing and selective laser sintering.The materials used were ABS resin,photosensitive resin,plaster and aluminum alloy.After sterilization,the guide plate was used for excision and reconstruction of bone tumor.After operation,the results of bone tumor surgery were checked by X-ray and CT.Results Digital design for individualized surgery and guide plate and manufacture of the guide plate by 3D printing were accomplished successfully preoperatively in all the 35 patients.Photosensitive resin was used in 17 cases,ABS resin in 10 cases,plaster in 5 cases and aluminum alloy in 3 cases.The guide plate penetrated the bone in 31 cases and the skin in 4.The resection and reconstruction were accomplished in accordance with the preoperative design in all but 3 cases who encountered breakage of plate during operation and had to change to conventional surgery.Postoperative X-ray and CT examinations showed good tumor resection and stable reconstruction.Conclusions 3D printing guide plates can well satisfy the requirements of individualized bone tumor resection and reconstruction.Since different 3D printing techniques lead to different features of the guide plate,they should be chosen according to the specific need of operation.