3D打印技术在先天性心脏病伴气管软化诊断与治疗中的应用
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摘要
目的:运用3D打印技术建立儿童先天性心脏病伴气管软化模型,探讨3D打印建模对于临床诊断和治疗方案制定的意义。方法:1例先天性心脏病伴气管软化的患儿,行容积螺旋穿梭技术(VHS)CT扫描后获得影像资料;将CT图像导入Mimics 17.0软件并对气管区域进行图像重建后处理,得到气管三维重建模型;再运用3-Matic10.0软件对三维模型进行网格优化操作并保存成STL格式;最后将数据导入Objet 260 3D打印机打印出三维模型。结果:利用3D打印构建了患儿吸气相和呼气相气管模型,与气管镜检查的结果一致。结论:通过3D打印技术打印了患儿的全尺寸气管模型,给先天性心脏病伴气管软化的临床诊断和治疗予以有效的协助和指导。
Objective To establish a three-dimensional(3D) airway model for pediatric patients congenital heart disease(CHD)accompanied by tracheomalacia through 3D printing technique and explore the significance of the 3D airway model for clinical diagnosis and the development of therapeutic schedule. Methods One pediatric patient was diagnosed with CHD accompanied by tracheomalacia, and the image data were obtained with dynamic multi-detector computer tomography(MDCT) with volume helical shuttle(VHS) technique. The DICOM data of CT image were imported into Mimics 17.0 software, and the image postprocessing was conducted in the region of interest, finally obtaining the 3D reconstruction models of these airways. Subsequently,3-Matic 10.0 software was used to do the mesh optimization of the 3D models and generate stereolithography(STL) files. After these files were imported into Objet 260 3D printer, the 3D airway models were finally printed with 3D printer. Results The 3D printed trachea models of inspiratory phase and expiratory phase were in accord with the results of bronchoscopy examination.Conclusion Pediatric full-sized trachea model is successfully established with the use of 3D printing technique, which provides an effective assistance and guidance to diagnose and provide treatment for pediatric patients who were suffered with CHD accompanied by tracheomalacia.
Objective To establish a three-dimensional(3D) airway model for pediatric patients congenital heart disease(CHD)accompanied by tracheomalacia through 3D printing technique and explore the significance of the 3D airway model for clinical diagnosis and the development of therapeutic schedule. Methods One pediatric patient was diagnosed with CHD accompanied by tracheomalacia, and the image data were obtained with dynamic multi-detector computer tomography(MDCT) with volume helical shuttle(VHS) technique. The DICOM data of CT image were imported into Mimics 17.0 software, and the image postprocessing was conducted in the region of interest, finally obtaining the 3D reconstruction models of these airways. Subsequently,3-Matic 10.0 software was used to do the mesh optimization of the 3D models and generate stereolithography(STL) files. After these files were imported into Objet 260 3D printer, the 3D airway models were finally printed with 3D printer. Results The 3D printed trachea models of inspiratory phase and expiratory phase were in accord with the results of bronchoscopy examination.Conclusion Pediatric full-sized trachea model is successfully established with the use of 3D printing technique, which provides an effective assistance and guidance to diagnose and provide treatment for pediatric patients who were suffered with CHD accompanied by tracheomalacia.
引文
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[5]王诗渝,钟玉敏,张磊,等.容积螺旋穿梭技术诊断儿童先天性心脏病伴气管软化[J].第二军医大学学报,2017,38(2):166-171.WANG S Y,ZHONG Y M,ZHANG L,et al.Dynamic multi-detector computer tomography with volume helical shuttle technique for diagnosis of congenital heart disease with tracheomalacia in children[J].Academic Journal of Second Military Medical University,2017,38(2):166-171.
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[7]张书新.胸部三维数字化建模的基础与临床初步应用研究[D].北京:中国人民解放军医学院,2016.ZHANG S X.The basic and clinical application of thoracic threedimensional digital modeling[D].Beijing:Chinese People's Liberation Army Medical College,2016.
[8]王娇,刘洋,张晓玲,等.Mimics软件在医学图像三维重建中的应用[J].医疗卫生装备,2015,36(2):115-118.WANG J,LIU Y,ZHANG X L,et al.Application of Mimics software to 3D reconstruction of medical image[J].Chinese Medical Equipment Journal,2015,36(2):115-118.
[9]赵志云,王文革,曹伟杰,等.医学三维模型的网格优化和效果研究[J].中国数字医学,2016,11(9):91-93.ZHAO Z Y,WANG W G,CAO W J,et al.Research of remeshing and effect on medical three-dimensional model[J].China Digital Medicine,2016,11(9):91-93.
[10]CARDEN K A,BOISELLE P M,WALTZ D A,et al.Tracheomalacia and tracheobronchomalacia in children and adults:an in-depth review[J].Chest,2005,127(3):984-1005.
[11]FRAQA J C,JENNINGS R W,KIM P C.Pediatric tracheomalacia[J].Semin Pediatr Surg,2016,25(3):156-164.
[12]张磊,殷勇,张皓,等.儿童气管支气管软化症的支气管镜与多层螺旋CT诊断对照研究[J].中国妇幼健康研究,2017,28(1):487.ZHANG L,YIN Y,ZHANG H,et al.Comparative study of bronchoscopy and multi-slice spiral CT in diagnosis and treatment of tracheobronchial stenosis in children[J].Chinese Journal of Woman and Child Health Research,2017,28(1):487.
[13]王浩,张恒一,王顺民,等.3D打印技术在先天性气管狭窄诊断与手术治疗中的应用[J].中国胸心血管外科临床杂志,2017,24(3):169-174.WANG H,ZHANG H Y,WANG S M,et al.Application of 3D printing in the diagnosis and surgical treatment of congenital tracheal stenosis[J].Chinese Journal of Clinical Thoracic and Cardiovascular Surgery,2017,24(3):169-174.
[14]LIOSON H,KURMAN M.Fabricated:the new world of 3D printing[M].New York:John Wiley&Sons,2013.
[15]伍冬冬,顾其华,潘频华,等.3D打印技术引导气道狭窄支架置入术一例[J].中国呼吸与危重监护杂志,2014,13(6):610-612.WU D D,GU Q H,PAN P H,et al.3D printing technique for guiding airway stenosis:a case report of stent placement[J].Chinese Journal of Respiratory and Critical Care Medicine,2014,13(6):610-612.
[16]MORRISON R J,HOLLISTER S J,NIEDNER M F,et al.Mitigation of tracheobronchomalacia with 3D-printed personalized medical devices in pediatric patients[J].Sci Transl Med,2015,7:285.
[17]SHIEH H F,JENNINGS R W.Three-dimensional printing of external airway splints for tracheomalacia[J].J Thorac Dis,2017,9(3):414-416.
[18]TAM M D,LAYCOCK S D,TAYNE D,et al.3-D printouts of the tracheobronchial tree generated from CT images as an aid to management in a case of tracheobronchial chondromalacia caused by relapsing polychondritis[J].J Radiol Case Rep,2013,7(8):34-43.
[19]刘凯,张学燕.3D打印机与CT三维重建的结合应用[J].实用医技杂志,2013,20(6):666.LIU K,ZHANG X Y.The combination of 3D printer and CT 3D reconstruction[J].Journal of Practical Medical Techniques,2013,20(6):666.
[20]ALALI A B,GRIFFIN M F,BUTLER P E.Three dimensional printing surgical applications[J].Eplasty,2015,15(37):352-367.
[2]朱丽敏,徐卓明,柳立平,等.气管支气管软化对儿童充血型先天性心脏病纠治术后早期恢复的影响[J].上海交通大学学报(医学版),2011,31(9):1277-1282.ZHU L M,XU Z M,LIU L P,et al.Effect of tracheobronchomalacia on early recovery after surgical repair for congestive congenital heart disease[J].Journal of Shanghai Jiaotong University(Medical Science),2011,31(9):1277-1282.
[3]MASTERS I B,ZIMMERMAN P V,PANDEYA N,et al.Quantified tracheobronchomalacia disorders and their clinical profiles in children[J].Chest,2008,133(2):461-467.
[4]TAN J Z,CROSSETT M,DITCHFIELD M.Dynamic volumetric computed tomographic assessment of the young paediatric airway:initial experience of rapid,non-invasive,four-dimensional technique[J].J Med Imaging Radiat Oncol,2013,57(2):141-148.
[5]王诗渝,钟玉敏,张磊,等.容积螺旋穿梭技术诊断儿童先天性心脏病伴气管软化[J].第二军医大学学报,2017,38(2):166-171.WANG S Y,ZHONG Y M,ZHANG L,et al.Dynamic multi-detector computer tomography with volume helical shuttle technique for diagnosis of congenital heart disease with tracheomalacia in children[J].Academic Journal of Second Military Medical University,2017,38(2):166-171.
[6]HYSINGER E B,PANITCH H B.Paediatric tracheomalacia[J].Paediatr Respir Rev,2016,17:9-15.
[7]张书新.胸部三维数字化建模的基础与临床初步应用研究[D].北京:中国人民解放军医学院,2016.ZHANG S X.The basic and clinical application of thoracic threedimensional digital modeling[D].Beijing:Chinese People's Liberation Army Medical College,2016.
[8]王娇,刘洋,张晓玲,等.Mimics软件在医学图像三维重建中的应用[J].医疗卫生装备,2015,36(2):115-118.WANG J,LIU Y,ZHANG X L,et al.Application of Mimics software to 3D reconstruction of medical image[J].Chinese Medical Equipment Journal,2015,36(2):115-118.
[9]赵志云,王文革,曹伟杰,等.医学三维模型的网格优化和效果研究[J].中国数字医学,2016,11(9):91-93.ZHAO Z Y,WANG W G,CAO W J,et al.Research of remeshing and effect on medical three-dimensional model[J].China Digital Medicine,2016,11(9):91-93.
[10]CARDEN K A,BOISELLE P M,WALTZ D A,et al.Tracheomalacia and tracheobronchomalacia in children and adults:an in-depth review[J].Chest,2005,127(3):984-1005.
[11]FRAQA J C,JENNINGS R W,KIM P C.Pediatric tracheomalacia[J].Semin Pediatr Surg,2016,25(3):156-164.
[12]张磊,殷勇,张皓,等.儿童气管支气管软化症的支气管镜与多层螺旋CT诊断对照研究[J].中国妇幼健康研究,2017,28(1):487.ZHANG L,YIN Y,ZHANG H,et al.Comparative study of bronchoscopy and multi-slice spiral CT in diagnosis and treatment of tracheobronchial stenosis in children[J].Chinese Journal of Woman and Child Health Research,2017,28(1):487.
[13]王浩,张恒一,王顺民,等.3D打印技术在先天性气管狭窄诊断与手术治疗中的应用[J].中国胸心血管外科临床杂志,2017,24(3):169-174.WANG H,ZHANG H Y,WANG S M,et al.Application of 3D printing in the diagnosis and surgical treatment of congenital tracheal stenosis[J].Chinese Journal of Clinical Thoracic and Cardiovascular Surgery,2017,24(3):169-174.
[14]LIOSON H,KURMAN M.Fabricated:the new world of 3D printing[M].New York:John Wiley&Sons,2013.
[15]伍冬冬,顾其华,潘频华,等.3D打印技术引导气道狭窄支架置入术一例[J].中国呼吸与危重监护杂志,2014,13(6):610-612.WU D D,GU Q H,PAN P H,et al.3D printing technique for guiding airway stenosis:a case report of stent placement[J].Chinese Journal of Respiratory and Critical Care Medicine,2014,13(6):610-612.
[16]MORRISON R J,HOLLISTER S J,NIEDNER M F,et al.Mitigation of tracheobronchomalacia with 3D-printed personalized medical devices in pediatric patients[J].Sci Transl Med,2015,7:285.
[17]SHIEH H F,JENNINGS R W.Three-dimensional printing of external airway splints for tracheomalacia[J].J Thorac Dis,2017,9(3):414-416.
[18]TAM M D,LAYCOCK S D,TAYNE D,et al.3-D printouts of the tracheobronchial tree generated from CT images as an aid to management in a case of tracheobronchial chondromalacia caused by relapsing polychondritis[J].J Radiol Case Rep,2013,7(8):34-43.
[19]刘凯,张学燕.3D打印机与CT三维重建的结合应用[J].实用医技杂志,2013,20(6):666.LIU K,ZHANG X Y.The combination of 3D printer and CT 3D reconstruction[J].Journal of Practical Medical Techniques,2013,20(6):666.
[20]ALALI A B,GRIFFIN M F,BUTLER P E.Three dimensional printing surgical applications[J].Eplasty,2015,15(37):352-367.