增材制造技术在骨缺损修复治疗中的应用
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摘要
背景:增材制造技术凭借其能快速精准制备出假体的优点,在骨缺损治疗方面应用广泛。目的:对增材制造技术在骨缺损方面的临床应用现状做一综述。方法:由第一作者检索PubMed、CNKI、万方数据库2000至2018年收录的有关增材制造与骨缺损的文献,中文检索词为"骨缺损,增材制造,3D打印技术,骨肿瘤",英文检索词为"Bone defect,Additive Manufacturing(AM),3D Printing,Bone tumour"。结果与结论:①增材制造技术能结合现代影像技术,快速进行体外的假体三维重建;②治疗骨缺损时不仅能在术前构建骨缺损模型进行模拟手术,熟悉和对比手术方式,有效减少实际手术时间;还能快速精准的制备出形状各异的植入物,明显提高手术成功率;③增材制造技术展现出在骨缺损临床应用方面的优势。
BACKGROUND: Additive material manufacturing technology is widely used in the treatment of bone defects because of its advantages of rapid and accurate preparation of prostheses.OBJECTIVE: To review the current situation of material addition technology applied in bone defects.METHODS: The first author searched the articles related to additive manufacturing and bone defect repair in PubMed, CNKI, and WanFang databases published from 2000 to 2018. The keywords were "bone defect,additive manufacturing(AM), 3D printing, bone tumour" in Chinese and English, respectively.RESULTS AND CONCLUSION:(1) The additive manufacturing technology can rapidly reconstruct the three-dimensional prosthesis in vitro with modern imaging technology.(2) In the treatment of bone defects, we cannot only establish the model of bone defects before operation to simulate the operation, familiarize and compare the operation methods, and effectively reduce the operation time, but also can quickly and accurately prepare different varieties of implants, significantly improving the success rate of surgery.(3) Additive manufacturing technology shows good prospects in the clinical application of bone defects.
BACKGROUND: Additive material manufacturing technology is widely used in the treatment of bone defects because of its advantages of rapid and accurate preparation of prostheses.OBJECTIVE: To review the current situation of material addition technology applied in bone defects.METHODS: The first author searched the articles related to additive manufacturing and bone defect repair in PubMed, CNKI, and WanFang databases published from 2000 to 2018. The keywords were "bone defect,additive manufacturing(AM), 3D printing, bone tumour" in Chinese and English, respectively.RESULTS AND CONCLUSION:(1) The additive manufacturing technology can rapidly reconstruct the three-dimensional prosthesis in vitro with modern imaging technology.(2) In the treatment of bone defects, we cannot only establish the model of bone defects before operation to simulate the operation, familiarize and compare the operation methods, and effectively reduce the operation time, but also can quickly and accurately prepare different varieties of implants, significantly improving the success rate of surgery.(3) Additive manufacturing technology shows good prospects in the clinical application of bone defects.
引文
[1]Brandoff JF,Silber JS,Vaccaro AR.Contemporary alternatives to synthetic bone grafts for spine surgery.Am JOrthop(Belle Mead NJ).2008;37(8):410-414.
[2]Maier SS,Pelin I,Bulacovschi V.Study on an injectable biomimetic hydroxyapatite--atelocollagen composite.Rev Med Chir Soc Med Nat Iasi.2007;111(4):1079-1083.
[3]Mueller TL,Wirth AJ,van Lenthe GH,et al.Mechanical stability in a human radius fracture treated with a novel tissue-engineered bone substitute:a non-invasive,longitudinal assessment using high-resolution p QCT in combination with finite element analysis.J Tissue Eng Regen Med.2011;5(5):415-420.
[4]Smith CA,Richardson SM,Eagle MJ,et al.The use of a novel bone allograft wash process to generate a biocompatible,mechanically stable and osteoinductive biological scaffold for use in bone tissue engineering.J Tissue Eng Regen Med.2015;9(5):595-604.
[5]左健,康建敏,潘乐.同种异体骨移植用于骨缺损修复的应用现状[J].中国组织工程研究,2012,16(18):3395-3398.
[6]Li J,Wang Z,Guo Z,et al.The use of allograft shell with intramedullary vascularized fibula graft for intercalary reconstruction after diaphyseal resection for lower extremity bony malignancy.J Surg Oncol.2010;102(5):368-374.
[7]陈宽冰,石文君,杨伟.胸骨肿瘤扩大切除及有机玻璃修补术的临床应用[J].中华肿瘤防治杂志,2009,16(2):150-151.
[8]张磊,张亦工,邢涛,等.记忆合金环抱式接骨板治疗锁骨骨折56例[J].卫生职业教育,2005,23(21):113-114.
[9]孟秀英,申铁兵,杨秀峰.用钛板钛钉治疗颌面部骨折[J].内蒙古医学杂志,2002,34(2):176.
[10]王迎军,杜昶,赵娜如,等.仿生人工骨修复材料研究[J].华南理工大学学报(自然科学版),2012,40(10):51-58.
[11]Asri R,Harun W,Samykano M,et al.Corrosion and surface modification on biocompatible metals:A review.Mater Sci Eng C Mater Biol Appl.2017;77:1261-1274.
[12]Li X,Yi W,Jin A,et al.Effects of sequentially released BMP-2and BMP-7 from PELA microcapsule-based scaffolds on the bone regeneration.Am J Transl Res.2015;7(8):1417-1428.
[13]Tang D,Tare RS,Yang LY,et al.Biofabrication of bone tissue:approaches,challenges and translation for bone regeneration.Biomaterials.2016;83:363-382.
[14]Cohen A,Laviv A,Berman P,et al.Mandibular reconstruction using stereolithographic 3-dimensional printing modeling technology.Oral Surg Oral Med Oral Pathol Oral Radiol Endod.2009;108(5):661-666.
[15]许森赫,王金成,范丽雯,等.国内外3D打印在骨科的发展状况[J].中国实验诊断学,2018,22(2):367-370.
[16]董青山,郭家平,李志进,等.基于快速成型技术即刻精确修复下颌骨缺损的临床研究[J].口腔医学研究,2012,28(11):1134-1137.
[17]Waran V,Menon R,Pancharatnam D,et al.The creation and verification of cranial models using three-dimensional rapid prototyping technology in field of transnasal sphenoid endoscopy.Am J Rhinol Allergy.2012;26(5):e132-e136.
[18]杜浩,赵致良,干阜生,等.三维重建结合快速成形术制作模板定位髋臼假体的临床应用[J].中国矫形外科杂志,2009,17(10):737-740.
[19]Nyberg EL,Farris AL,Hung BP,et al.3D-Printing Technologies for Craniofacial Rehabilitation,Reconstruction,and Regeneration.Ann Biomed Eng.2017;45(1):45-57.
[20]何汉晖,刘永裕,林晓光.3D打印技术在修复骨缺损中的应用研究[J].现代诊断与治疗,2017,28(14):2714-2715.
[21]Meseguer-olmo L,Vicente-ortega V,Alcaraz-banos M,et al.In-vivo behavior of Si-hydroxyapatite/polycaprolactone/DMBscaffolds fabricated by 3D printing.J Biomed Mater Res A.2013;101(7):2038-2048.
[22]Zhang YZ,Lu S,Yang Y,et al.Design and primary application of computer-assisted,patient-specific navigational templates in metal-on-metal hip resurfacing arthroplasty.J Arthroplasty.2011;26(7):1083-1087.
[23]施伟,罗飞.基于CT数据的颌骨支架材料有限元分析及3D打印模型研究[J].基因组学与应用生物学,2018,37(10):4553-4559.
[24]马成.计算机辅助设计与3D打印技术结合血管化腓骨游离移植修复下颌骨缺损的应用研究[D].南宁:广西医科大学,2018.
[25]Azuma M,Yanagawa T,Ishibashi-kanno N,et al.Mandibular reconstruction using plates prebent to fit rapid prototyping3-dimensional printing models ameliorates contour deformity.Head Face Med.2014;10:45.
[26]Engel M,Hoffmann J,Castrillon-oberndorfer G,et al.The value of three-dimensional printing modelling for surgical correction of orbital hypertelorism.Oral Maxillofac Surg.2015;19(1):91-95.
[27]Nkenke E,Eitner S.Complex hemimaxillary rehabilitation with a prefabricated fibula flap and cast-based vacuum-formed surgical template.J Prosthet Dent.2014;111(6):521-524.
[28]Jardini AL,Larosa MA,Maciel FR,et al.Cranial reconstruction:3D biomodel and custom-built implant created using additive manufacturing.J Craniomaxillofac Surg.2014;42(8):1877-1884.
[29]龚振宇,李国华,刘彦普,等.反求与快速成型技术在复杂颌面骨性病变修复中的应用[J].疑难病杂志,2011,10(10):767-770.
[30]Mao Y,Xu C,Xu J,et al.The use of customized cages in revision total hip arthroplasty for Paprosky type III acetabular bone defects.Int Orthop.2015;39(10):2023-2030.
[31]Han Q,Zhao X,Wang C,et al.Individualized reconstruction for severe periprosthetic fractures around the tumor prosthesis of knee under assistance of 3D printing technology:A case report.Medicine(Baltimore).2018;97(42):e12726.
[32]Guo T,Noshin M,Baker HB,et al.3D printed biofunctionalized scaffolds for microfracture repair of cartilage defects.Biomaterials.2018;185:219-231.
[33]Zhang Y,Zhang L,Sun R,et al.A new 3D printed titanium metal trabecular bone reconstruction system for early osteonecrosis of the femoral head.Medicine(Baltimore).2018;97(26):e11088.
[34]Xu N,Wei F,Liu X,et al.Reconstruction of the Upper Cervical Spine Using a Personalized 3D-Printed Vertebral Body in an Adolescent With Ewing Sarcoma.Spine(Phila Pa 1976).2016;41(1):E50-E54.
[35]Choy WJ,Mobbs RJ,Wilcox B,et al.Reconstruction of Thoracic Spine Using a Personalized 3D-Printed Vertebral Body in Adolescent with T9 Primary Bone Tumor.World Neurosurg.2017;105:1013-1032.
[36]Wei R,Guo W,Ji T,et al.One-step reconstruction with a3D-printed,custom-made prosthesis after total en bloc sacrectomy:a technical note.Eur Spine J.2017;26(7):1902-1909.
[37]Mobbs RJ,Coughlan M,Thompson R,et al.The utility of 3Dprinting for surgical planning and patient-specific implant design for complex spinal pathologies:case report.JNeurosurg Spine.2017;26(4):513-518.
[38]Xiao JR,Huang WD,Yang XH,et al.En bloc resection of primary malignant bone tumor in the cervical spine based on3-dimensional printing technology.Orthop Surg.2016;8(2):171-178.
[39]方旭,董军峰,赵红卫,等.结核性骨缺损重建材料应用现状[J].中国组织工程研究,2019,23(2):298-303.
[40]董军峰.载利福平多孔复合物作为结核性骨缺损修复材料的研究[D].武汉:华中科技大学,2014.
[41]Cartiaux O,Docquier PL,Paul L,et al.Surgical inaccuracy of tumor resection and reconstruction within the pelvis:an experimental study.Acta Orthop.2008;79(5):695-702.
[42]Morris GV,Stevenson JD,Evans S,et al.Navigation in Musculoskeletal Oncology:An Overview.Indian J Orthop.2018;52(1):22-30.
[43]Gouin F,Paul L,Odri GA,et al.Computer-assisted planning and patient-specific instruments for bone tumor resection within the pelvis:a series of 11 patients.Sarcoma.2014;2014:842709.
[44]Wong KC,Kumta SM,Geel NV,et al.One-step reconstruction with a 3D-printed,biomechanically evaluated custom implant after complex pelvic tumor resection.Comput Aided Surg.2015;20(1):14-23.
[45]Chen X,Xu L,Wang Y,et al.Image-guided installation of3D-printed patient-specific implant and its application in pelvic tumor resection and reconstruction surgery.Comput Methods Programs Biomed.2016;125:66-78.
[46]Liang H,Ji T,Zhang Y,et al.Reconstruction with 3D-printed pelvic endoprostheses after resection of a pelvic tumour.Bone Joint J.2017;99-B(2):267-275.
[47]Iqbal T,Shi L,Wang L,et al.Development of finite element model for customized prostheses design for patient with pelvic bone tumor.Proc Inst Mech Eng H.2017;231(6):525-533.
[2]Maier SS,Pelin I,Bulacovschi V.Study on an injectable biomimetic hydroxyapatite--atelocollagen composite.Rev Med Chir Soc Med Nat Iasi.2007;111(4):1079-1083.
[3]Mueller TL,Wirth AJ,van Lenthe GH,et al.Mechanical stability in a human radius fracture treated with a novel tissue-engineered bone substitute:a non-invasive,longitudinal assessment using high-resolution p QCT in combination with finite element analysis.J Tissue Eng Regen Med.2011;5(5):415-420.
[4]Smith CA,Richardson SM,Eagle MJ,et al.The use of a novel bone allograft wash process to generate a biocompatible,mechanically stable and osteoinductive biological scaffold for use in bone tissue engineering.J Tissue Eng Regen Med.2015;9(5):595-604.
[5]左健,康建敏,潘乐.同种异体骨移植用于骨缺损修复的应用现状[J].中国组织工程研究,2012,16(18):3395-3398.
[6]Li J,Wang Z,Guo Z,et al.The use of allograft shell with intramedullary vascularized fibula graft for intercalary reconstruction after diaphyseal resection for lower extremity bony malignancy.J Surg Oncol.2010;102(5):368-374.
[7]陈宽冰,石文君,杨伟.胸骨肿瘤扩大切除及有机玻璃修补术的临床应用[J].中华肿瘤防治杂志,2009,16(2):150-151.
[8]张磊,张亦工,邢涛,等.记忆合金环抱式接骨板治疗锁骨骨折56例[J].卫生职业教育,2005,23(21):113-114.
[9]孟秀英,申铁兵,杨秀峰.用钛板钛钉治疗颌面部骨折[J].内蒙古医学杂志,2002,34(2):176.
[10]王迎军,杜昶,赵娜如,等.仿生人工骨修复材料研究[J].华南理工大学学报(自然科学版),2012,40(10):51-58.
[11]Asri R,Harun W,Samykano M,et al.Corrosion and surface modification on biocompatible metals:A review.Mater Sci Eng C Mater Biol Appl.2017;77:1261-1274.
[12]Li X,Yi W,Jin A,et al.Effects of sequentially released BMP-2and BMP-7 from PELA microcapsule-based scaffolds on the bone regeneration.Am J Transl Res.2015;7(8):1417-1428.
[13]Tang D,Tare RS,Yang LY,et al.Biofabrication of bone tissue:approaches,challenges and translation for bone regeneration.Biomaterials.2016;83:363-382.
[14]Cohen A,Laviv A,Berman P,et al.Mandibular reconstruction using stereolithographic 3-dimensional printing modeling technology.Oral Surg Oral Med Oral Pathol Oral Radiol Endod.2009;108(5):661-666.
[15]许森赫,王金成,范丽雯,等.国内外3D打印在骨科的发展状况[J].中国实验诊断学,2018,22(2):367-370.
[16]董青山,郭家平,李志进,等.基于快速成型技术即刻精确修复下颌骨缺损的临床研究[J].口腔医学研究,2012,28(11):1134-1137.
[17]Waran V,Menon R,Pancharatnam D,et al.The creation and verification of cranial models using three-dimensional rapid prototyping technology in field of transnasal sphenoid endoscopy.Am J Rhinol Allergy.2012;26(5):e132-e136.
[18]杜浩,赵致良,干阜生,等.三维重建结合快速成形术制作模板定位髋臼假体的临床应用[J].中国矫形外科杂志,2009,17(10):737-740.
[19]Nyberg EL,Farris AL,Hung BP,et al.3D-Printing Technologies for Craniofacial Rehabilitation,Reconstruction,and Regeneration.Ann Biomed Eng.2017;45(1):45-57.
[20]何汉晖,刘永裕,林晓光.3D打印技术在修复骨缺损中的应用研究[J].现代诊断与治疗,2017,28(14):2714-2715.
[21]Meseguer-olmo L,Vicente-ortega V,Alcaraz-banos M,et al.In-vivo behavior of Si-hydroxyapatite/polycaprolactone/DMBscaffolds fabricated by 3D printing.J Biomed Mater Res A.2013;101(7):2038-2048.
[22]Zhang YZ,Lu S,Yang Y,et al.Design and primary application of computer-assisted,patient-specific navigational templates in metal-on-metal hip resurfacing arthroplasty.J Arthroplasty.2011;26(7):1083-1087.
[23]施伟,罗飞.基于CT数据的颌骨支架材料有限元分析及3D打印模型研究[J].基因组学与应用生物学,2018,37(10):4553-4559.
[24]马成.计算机辅助设计与3D打印技术结合血管化腓骨游离移植修复下颌骨缺损的应用研究[D].南宁:广西医科大学,2018.
[25]Azuma M,Yanagawa T,Ishibashi-kanno N,et al.Mandibular reconstruction using plates prebent to fit rapid prototyping3-dimensional printing models ameliorates contour deformity.Head Face Med.2014;10:45.
[26]Engel M,Hoffmann J,Castrillon-oberndorfer G,et al.The value of three-dimensional printing modelling for surgical correction of orbital hypertelorism.Oral Maxillofac Surg.2015;19(1):91-95.
[27]Nkenke E,Eitner S.Complex hemimaxillary rehabilitation with a prefabricated fibula flap and cast-based vacuum-formed surgical template.J Prosthet Dent.2014;111(6):521-524.
[28]Jardini AL,Larosa MA,Maciel FR,et al.Cranial reconstruction:3D biomodel and custom-built implant created using additive manufacturing.J Craniomaxillofac Surg.2014;42(8):1877-1884.
[29]龚振宇,李国华,刘彦普,等.反求与快速成型技术在复杂颌面骨性病变修复中的应用[J].疑难病杂志,2011,10(10):767-770.
[30]Mao Y,Xu C,Xu J,et al.The use of customized cages in revision total hip arthroplasty for Paprosky type III acetabular bone defects.Int Orthop.2015;39(10):2023-2030.
[31]Han Q,Zhao X,Wang C,et al.Individualized reconstruction for severe periprosthetic fractures around the tumor prosthesis of knee under assistance of 3D printing technology:A case report.Medicine(Baltimore).2018;97(42):e12726.
[32]Guo T,Noshin M,Baker HB,et al.3D printed biofunctionalized scaffolds for microfracture repair of cartilage defects.Biomaterials.2018;185:219-231.
[33]Zhang Y,Zhang L,Sun R,et al.A new 3D printed titanium metal trabecular bone reconstruction system for early osteonecrosis of the femoral head.Medicine(Baltimore).2018;97(26):e11088.
[34]Xu N,Wei F,Liu X,et al.Reconstruction of the Upper Cervical Spine Using a Personalized 3D-Printed Vertebral Body in an Adolescent With Ewing Sarcoma.Spine(Phila Pa 1976).2016;41(1):E50-E54.
[35]Choy WJ,Mobbs RJ,Wilcox B,et al.Reconstruction of Thoracic Spine Using a Personalized 3D-Printed Vertebral Body in Adolescent with T9 Primary Bone Tumor.World Neurosurg.2017;105:1013-1032.
[36]Wei R,Guo W,Ji T,et al.One-step reconstruction with a3D-printed,custom-made prosthesis after total en bloc sacrectomy:a technical note.Eur Spine J.2017;26(7):1902-1909.
[37]Mobbs RJ,Coughlan M,Thompson R,et al.The utility of 3Dprinting for surgical planning and patient-specific implant design for complex spinal pathologies:case report.JNeurosurg Spine.2017;26(4):513-518.
[38]Xiao JR,Huang WD,Yang XH,et al.En bloc resection of primary malignant bone tumor in the cervical spine based on3-dimensional printing technology.Orthop Surg.2016;8(2):171-178.
[39]方旭,董军峰,赵红卫,等.结核性骨缺损重建材料应用现状[J].中国组织工程研究,2019,23(2):298-303.
[40]董军峰.载利福平多孔复合物作为结核性骨缺损修复材料的研究[D].武汉:华中科技大学,2014.
[41]Cartiaux O,Docquier PL,Paul L,et al.Surgical inaccuracy of tumor resection and reconstruction within the pelvis:an experimental study.Acta Orthop.2008;79(5):695-702.
[42]Morris GV,Stevenson JD,Evans S,et al.Navigation in Musculoskeletal Oncology:An Overview.Indian J Orthop.2018;52(1):22-30.
[43]Gouin F,Paul L,Odri GA,et al.Computer-assisted planning and patient-specific instruments for bone tumor resection within the pelvis:a series of 11 patients.Sarcoma.2014;2014:842709.
[44]Wong KC,Kumta SM,Geel NV,et al.One-step reconstruction with a 3D-printed,biomechanically evaluated custom implant after complex pelvic tumor resection.Comput Aided Surg.2015;20(1):14-23.
[45]Chen X,Xu L,Wang Y,et al.Image-guided installation of3D-printed patient-specific implant and its application in pelvic tumor resection and reconstruction surgery.Comput Methods Programs Biomed.2016;125:66-78.
[46]Liang H,Ji T,Zhang Y,et al.Reconstruction with 3D-printed pelvic endoprostheses after resection of a pelvic tumour.Bone Joint J.2017;99-B(2):267-275.
[47]Iqbal T,Shi L,Wang L,et al.Development of finite element model for customized prostheses design for patient with pelvic bone tumor.Proc Inst Mech Eng H.2017;231(6):525-533.