3D打印技术在脊柱外科的应用

doi:10.3969/j.issn.2095-4344.2016.04.022

中国组织工程研究 ›› 2016, Vol. 20 ›› Issue (4): 577-582.doi: 10.3969/j.issn.2095-4344.2016.04.022

• 骨与关节综述 bone and joint review • 上一篇下一篇

3D打印技术在脊柱外科的应用

庞骄阳¹，赵岩²，肖宇龙²，辛大奇²

¹内蒙古医科大学，内蒙古自治区呼和浩特市 010030；²内蒙古医科大学第二附属医院胸腰椎脊柱外科，内蒙古自治区呼和浩特市 010030

收稿日期:2015-11-13 出版日期:2016-01-22 发布日期:2016-01-22
作者简介:Pang Jiao-yang, Studying for master’s degree, Inner Mongolia Medical University, Huhhot 010030, Inner Mongolia Autonomous Region, China
基金资助:
国家自然科学基金委员会资助项目(81441057)，项目名称：生物力学有限元分析及3D打印技术在退行性脊柱侧弯手术治疗中的应用研究

Application of three-dimensional printing technology in spinal surgery

Pang Jiao-yang¹, Zhao Yan², Xiao Yu-long², Xin Da-qi²

¹Inner Mongolia Medical University, Huhhot 010030, Inner Mongolia Autonomous Region, China;^{2Department of Thoracolumbar Spine Surgery, the Second Affiliated Hospital of Inner Mongolia Medical University, Huhhot 010030, Inner Mongolia Autonomous Region, China}

Received:2015-11-13 Online:2016-01-22 Published:2016-01-22
Contact: Zhao Yan, Associate chief physician, M.D., Master’s supervisor, Department of Thoracolumbar Spine Surgery, the Second Affiliated Hospital of Inner Mongolia Medical University, Huhhot 010030, Inner Mongolia Autonomous Region, China
About author:Pang Jiao-yang, Studying for master’s degree, Inner Mongolia Medical University, Huhhot 010030, Inner Mongolia Autonomous Region, China
Supported by:
the National Natural Science Foundation of China, No. 81441057

摘要/Abstract

摘要：

文章快速阅读：

文题释义：

椎弓根钉道导板：利用计算机软件三维重建椎体模型，标记术中需要置钉暴露的骨组织范围，利用逆向工程技术，制作出与椎体贴合的导板基地，设计进针点及角度，完成导板三维设计，最后利用3D打印技术打印导板模型，辅助椎体置钉。

3D打印技术：是一种可以将虚拟的计算机辅助设计模型准确快速的转化为三维实物原型的新型技术。3D打印实物模型方法可取代传统的术前规划与修复手术模拟方法，并具有可重复性，在脊柱外科的临床应用中日益深入。

背景：3D打印技术是一种可以将虚拟的计算机辅助设计模型准确快速的转化为三维实物原型的新型技术。3D打印实物模型方法可取代传统的术前规划与修复手术模拟方法，并具有可重复性，在脊柱外科的临床应用中日益深入。

目的：总结3D打印技术在脊柱外科的应用现状并展望其未来的发展方向。

方法：检索 PubMed 数据库、谷歌学术、中国知网数据库(CNKI)以及万方数据库(WF) 2000年1月至2015 年7月发表有关3D打印技术在脊柱外科应用的文献。(以“3D打印技术、快速成型技术、脊柱、脊椎、骨科、骨折、关节、手足、骨肿瘤、创伤、颈椎、胸椎、腰椎、骶椎、椎弓根、椎体、椎间盘、临床应用”为检索词。排除重复性研究及综述，选择代表性好的文章共50篇进行讨论。)

结果与结论：3D打印技术已应用于脊柱外科的术前诊断、个体化支具定制、医患沟通、教学、个体化高精度修复方案制定、术中导航、个体化内置物定制等方面。提示随着医学影像学、数字化医学、组织细胞培养技术和新材料技术的快速发展，3D打印技术在脊柱外科的应用将会更为深入广泛。

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

ORCID: 0000-0001-7583-4681(赵岩)

关键词: 骨科植入物, 脊柱植入物, 3D打印技术, 脊柱外科, 临床应用, 国家自然科学基金

Abstract:

BACKGROUND: Three-dimensional printing technology is a new technology which can quickly and accurately transform the virtual computer-aided design into the three-dimensional physical prototypes. Three-dimensional printing physical model method can replace the method of traditional preoperative planning and repair surgical simulation, with the characteristic of repeatable, which has been deepened day after day in clinical application of spine surgery.
OBJECTIVE: To summarize the application status of three-dimensional printing technology in spine surgery and look forward to its future development directions.
METHODS: The articles regarding the application of three-dimensional printing technology on clinical applications in spine surgery were retrieved from PubMed databases, Google Scholar, China National Knowledge Infrastructure and Wanfang Database from January 2000 to July 2015. The key words were 3D printing technology, rapid prototyping technology, spine, vertebra, department of orthopedics, fracture, joint, hand and foot, bone tumor, trauma, cervical vertebrae, thoracic vertebrae, lumbar vertebrae, sacral vertebrae, pedicle of vertebral arch, vertebral body, intervertebral disc, and clinical application. A total of 50 articles with a good representation were selected and discussed after repetitive studies and reviews were excluded.
RESULTS AND CONCLUSION: The three-dimensional printing technique has been applied in preoperative diagnosis, individualized orthosis customerization, the communication between doctors and patients, teaching, the formulation of individualized and high-accurate repairing plan, intraoperative navigation and individualized implant customization. These results suggest that with the rapid development of medical imaging, digital medicine and technologies of the cell and tissue culture and new materials, three-dimensional printing technology will have a wide range of applications in spine surgery.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

庞骄阳，赵岩，肖宇龙，辛大奇. 3D打印技术在脊柱外科的应用[J]. 中国组织工程研究, 2016, 20(4): 577-582.

Pang Jiao-yang, Zhao Yan, Xiao Yu-long, Xin Da-qi. Application of three-dimensional printing technology in spinal surgery[J]. Chinese Journal of Tissue Engineering Research, 2016, 20(4): 577-582.

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引言

材料方法

讨论

脊柱解剖结构复杂，部位深在，周围毗邻神经及血管，手术风险较高。而手术成功的关键与正确的疾病诊断、责任节段的定位以及合理的术前规划密切相关，随着3D打印技术的不断发展以及人们对3D打印技术在临床方面的应用研究，借助3D打印技术，对脊柱疾病患者进行疾病诊断、医患沟通、术前规划设计，手术模拟操作、优化手术器械、预测评估手术效果等提供了一种新的方法。

3D打印技术既能明显提高手术的成功率，缩短手术时间，提高手术的精确性，又能有效地减少手术并发症的发生。3D打印技术做为一种新的仿真学研究方法，具有精确性、可重复性、安全性的优点，目前已经在脊柱外科研究领域中广泛应用。

目前3D打印技术的在脊柱外科的应用已经逐渐渗透到多个方面，但大都集中在钉道导板的椎弓根置钉应用及术前手术方案规划与模拟上，而在基础研究中3D打印骨组织工程研究较多，3D打印技术的基础在于影像学资料的质量，计算机三维重建的三维模型与患者实体有一定的的差别，影像资料的质量越高计算机三维重建的实物模型的仿真性越高，越接近患者脊柱实体的解剖结构。

相信随着相关技术的发展，3D打印技术在脊柱外科领域的应用会进一步深入，如随着影像学的发展，利用3D打印技术打印脊柱局部部位的三维解剖结构，辅助脊柱外科相关疾病的精确诊断、提高医患沟通和教学的效果、定制个体化高精度修复方案、术中多样式钉道导板定制等应用也将逐步得到推广，随着人体工程学的引入，个体化定制脊柱支具也将逐步推广，而随着材料学的发展，3D打印个体化内植物也将进入临床应用，而随着生物材料学、组织细胞培养技术以及3D打印技术的发展，实现细胞打印骨组织修复脊柱骨组织缺损将成为可能。

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

3D打印技术在脊柱外科的应用

Application of three-dimensional printing technology in spinal surgery

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