3D打印技术在骨科的应用研究
|
摘要
3D打印呈现井喷式的发展,该技术在骨科的应用是一个热门的研究方向。本文阐述了3D打印技术在骨科方面的应用近况,主要对该技术在术前规划、术中导航、临床教学、医患沟通、康复支具、骨科内植物、生物打印等多个方面的应用进行综述,归纳了3D打印技术运用于骨科的优势,总结了目前存在的一些技术难点,并对3D打印技术在大块骨缺损的修复、假肢等方面的应用进行了展望。
In recent years, three-dimensional(3 D) printing technology has been developed rapidly. The application of 3 D printing technology in orthopedics has been a hot research topic. Herein the applications of 3 D printing technology in orthopedics, mainly in preoperative planning, intraoperative navigation, clinical teaching, doctor-patient communication, rehabilitation brace,orthopaedics implants and bioprinting, are reviewed. Besides, the advantages and technical difficulties of 3 D printing technology in orthopaedics are summarized. Finally, the applications of 3 D printing technology in the repair of large bone defect and prosthesis are prospected.
In recent years, three-dimensional(3 D) printing technology has been developed rapidly. The application of 3 D printing technology in orthopedics has been a hot research topic. Herein the applications of 3 D printing technology in orthopedics, mainly in preoperative planning, intraoperative navigation, clinical teaching, doctor-patient communication, rehabilitation brace,orthopaedics implants and bioprinting, are reviewed. Besides, the advantages and technical difficulties of 3 D printing technology in orthopaedics are summarized. Finally, the applications of 3 D printing technology in the repair of large bone defect and prosthesis are prospected.
引文
[1] JOSE R R, RODRIQUEZ M J, DIXON T A, et al. Evolution of bioinksand additive manufacturing technologies for 3D bioprinting[J]. ACSBiomater Sci Eng, 2016, 2(10):1662-1678.
[2]张学军,唐思熠,肇恒跃,等. 3D打印技术研究现状和关键技术[J].材料工程, 2016, 44(2):122-128.ZHANG X J, TANG S Y, ZHAO H Y, et al. Research status and keytechnologies of 3D printing[J]. Journal of Materials Engineering,2016, 44(2):122-128.
[3] WONG K C. 3D-printed patient-specific applications in orthopedics[J]. Orthop Res Rev, 2016, 8(8):57-66.
[4] CARTIAUX O, PAUL L, FRANCQ B G, et al. Improved accuracywith 3D planning and patient-specific instruments during simulatedpelvic bone tumor surgery[J]. Ann Biomed Eng, 2014, 42(1):205-213.
[5]孙涛,崔林江,窦超超. 3D打印技术在骨肿瘤手术术前规划中的初步应用[J].中国数字医学, 2016, 11(9):74-76.SUN T, CUI L J, DOU C C. Primary clinical application of 3Dprinting technique in born tumor operation design[J]. ChinaDigital Medicine, 2016, 11(9):74-76.
[6]柳鑫,曾参军,卢键森,等. 3D打印计算机虚拟辅助技术在髋臼骨折术前规划中的应用[J].南方医科大学学报, 2017, 37(3):378-382.LIU X, ZENG C J, LU J S, et al. Application of 3D printing andcomputer-assisted surgical simulation in preoperative planning foracetabular fracture[J]. Journal of Southern Medical University, 2017,37(3):378-382.
[7]黄华军,张国栋,欧阳汉斌,等.基于3D打印技术的复杂胫骨平台骨折内固定手术数字化设计[J].南方医科大学学报, 2015, 35(2):218-222.HUANG H J, ZHANG G D, OUYANG H B, et al. Internal fixationsurgery planning for complex tibial plateau fracture based on digitaldesign and 3D printing[J]. Journal of Southern Medical University,2015, 35(2):218-222.
[8] ZENG C J, XING W R, WU Z L, et al. A combination of three-dimensional printing and computer-assisted virtual surgical procedurefor preoperative planning of acetabular fracture reduction[J].Injury, 2016, 47(10):2223-2227.
[9]盛晓磊,袁峰,李智多,等. 3D打印组合式导板辅助下颈椎前路椎弓根螺钉置入与徒手置钉的准确性对比[J].中国组织工程研究,2017, 21(3):406-411.SHENG X L, YUAN F, LI Z D, et al. Comparison of the accuracy oflower cervical anterior transpedicular screws between three-dimensional printing assembly navigation template and free handplacement[J]. Journal of Clinical Rehabilitative Tissue EngineeringResearch, 2017, 21(3):406-411.
[10]朱文艺,海涌,李健,等.多元化教学方式在骨科临床教学中的应用研究[J].中国病案, 2015, 16(4):87-89.ZHU W Y, HAI Y, LI J, et al. Applied research of diversifiedteaching methods in orthopaedic clinical teaching[J]. ChineseMedical Record, 2015, 16(4):87-89.
[11]PUJOL S, BALDWIN M, NASSIRI J, et al. Using 3D modelingtechniques to enhance teaching of difficult anatomical concepts[J].Acad Radiol, 2016, 23(4):507-516.
[12]李忠海,唐家广,王华东,等. 3D打印技术在骨科临床教学中的应用初探[J].中国医学教育技术, 2016, 30(2):198-200.LI Z H, TANG J G, WANG H D, et al. Exploration of 3D printingtechnology applied in orthopedic clinical teaching[J]. China MedicalEducation Technology, 2016, 30(2):198-200.
[13]EISENMENGER L B, WIGGINS R H, FULTS D W, et al. Applicationof 3D printing in a case of osteogenesis imperfecta for patienteducation, anatomic understanding, preoperative planning, andintraoperative evaluation[J]. World Neurosurg, 2017, 107:1049.
[14]廖政文,莫诒向,张国栋,等. 3D打印个性化康复矫形器的设计制作[J].中国医学物理学杂志, 2018, 35(4):470-477.LIAO Z W, MO Y X, ZHANG G D, et al. Design and development ofthree-dimensional printing personalized rehabilitation orthosis[J].Chinese Journal of Medical Physics, 2018, 35(4):470-477.
[15]陆亮亮,史廷春,于云,等. 3D打印指骨骨折支具的研究[J].航天医学与医学工程, 2017, 30(4):263-269.LU L L, SHI Y C, YU Y, et al. Study on 3D printed brace forphalangeal fractures[J]. Space Medicine&Medical Engineering,2017, 30(4):263-269.
[16]MOK S W, NIZAK R, FU S C, et al. From the printer:potential ofthree-dimensional printing for orthopaedic applications[J]. J OrthopTranslat, 2016, 6(C):42-49.
[17]刘忠军.金属3D打印骨科内植物的应用现状与发展趋势浅析[J].骨科临床与研究杂志, 2017, 2(2):65-67.LIU Z J. Application and development trend of metallic 3D printingplants in orthopaedics[J]. The Journal of Orthopaedic Clinical andResearch Studies, 2017, 2(2):65-67.
[18]黄淦,禹宝庆,敖荣广,等. 3D打印结合定制钢板内固定技术在骨盆骨折治疗中的应用[J].中华创伤杂志, 2016, 32(12):1060-1066.HUANG G, YU B Q, AO R G, et al. Application of three-dimensionalprinting combined with individualized custom-made plate in internalfixation of pelvic fractures[J]. Chinese Journal of Trauma, 2016, 32(12):1060-1066.
[19]CUI H, NOWICKI M, FISHER J P, et al. 3D bioprinting for organregeneration[J]. Adv Healthc Mater, 2016, 6(1):1601118.
[20]WANG C, ZHAO Q, WANG M. Cryogenic 3D printing for producinghierarchical porous and rh BMP-2-loaded Ca-P/PLLA nanocompositescaffolds for bone tissue engineering[J]. Biofabrication, 2017, 9(2):025031.
[21]张明,赖毓霄,王新峦,等.基于3D打印技术的新型生物活性复合镁骨修复支架[J].国际骨科学杂志, 2015, 36(5):382-384.ZHANG M, LAI Y X, WANG X L, et al. A novel bioactive magnesiumbone repair scaffold based on 3 D printing technology[J].InternationalJournal of Orthopaedics, 2015, 36(5):382-384.
[22]郭鹏年,董乐乐,左强,等. 3D打印技术在创伤骨科中的临床应用[J].中国数字医学, 2015, 10(6):45-47.GUO P N, DONG L L, ZUO Q, et al.The clinical application of 3Dprinting technique in trauma orthopedics[J]. China Digital Medicine,2015, 10(6):45-47.
[23]冯均伟,王跃,朱宗,等.骨科人工关节置换术后金属过敏研究进展[J].实用医院临床杂志, 2012, 9(3):166-169.FENG J W, WANG Y, ZHU Z, et al. Research progress in metal allergyafter prosthetic replacement of joint in orthopedics department[J].Practical Journal of Clinical Medicine, 2012, 9(3):166-169.
[24]SEITZ H, RIEDER W, IRSEN S, et al. Three-dimensional printing ofporous ceramic scaffolds for bone tissue engineering[J]. J BiomedMater Res B Appl Biomater, 2005, 74(2):782-788.
[25]张海峰,杜子婧,毛曦媛,等. 3D打印PLA-HA复合材料构建组织工程骨的实验研究[J].国际骨科学杂志, 2016, 37(1):57-63.ZHANG H F, DU Z J, MAO X Y, et al. Experimental reserarch ofconstructing tissue engineered bone using three-dimensional printedpolylactic acid-hydroxyapatite composite scaffolds[J]. InternationalJournal of Orthopaedics, 2016, 37(1):57-63.
[26]XIE P, OUYANG H, DENG Y, et al. Comparison of conventionalreconstruction plate versus direct metal laser sintering plate:an in vitromechanical characteristics study[J]. J Orthop Surg Res, 2017, 12(1):128.
[2]张学军,唐思熠,肇恒跃,等. 3D打印技术研究现状和关键技术[J].材料工程, 2016, 44(2):122-128.ZHANG X J, TANG S Y, ZHAO H Y, et al. Research status and keytechnologies of 3D printing[J]. Journal of Materials Engineering,2016, 44(2):122-128.
[3] WONG K C. 3D-printed patient-specific applications in orthopedics[J]. Orthop Res Rev, 2016, 8(8):57-66.
[4] CARTIAUX O, PAUL L, FRANCQ B G, et al. Improved accuracywith 3D planning and patient-specific instruments during simulatedpelvic bone tumor surgery[J]. Ann Biomed Eng, 2014, 42(1):205-213.
[5]孙涛,崔林江,窦超超. 3D打印技术在骨肿瘤手术术前规划中的初步应用[J].中国数字医学, 2016, 11(9):74-76.SUN T, CUI L J, DOU C C. Primary clinical application of 3Dprinting technique in born tumor operation design[J]. ChinaDigital Medicine, 2016, 11(9):74-76.
[6]柳鑫,曾参军,卢键森,等. 3D打印计算机虚拟辅助技术在髋臼骨折术前规划中的应用[J].南方医科大学学报, 2017, 37(3):378-382.LIU X, ZENG C J, LU J S, et al. Application of 3D printing andcomputer-assisted surgical simulation in preoperative planning foracetabular fracture[J]. Journal of Southern Medical University, 2017,37(3):378-382.
[7]黄华军,张国栋,欧阳汉斌,等.基于3D打印技术的复杂胫骨平台骨折内固定手术数字化设计[J].南方医科大学学报, 2015, 35(2):218-222.HUANG H J, ZHANG G D, OUYANG H B, et al. Internal fixationsurgery planning for complex tibial plateau fracture based on digitaldesign and 3D printing[J]. Journal of Southern Medical University,2015, 35(2):218-222.
[8] ZENG C J, XING W R, WU Z L, et al. A combination of three-dimensional printing and computer-assisted virtual surgical procedurefor preoperative planning of acetabular fracture reduction[J].Injury, 2016, 47(10):2223-2227.
[9]盛晓磊,袁峰,李智多,等. 3D打印组合式导板辅助下颈椎前路椎弓根螺钉置入与徒手置钉的准确性对比[J].中国组织工程研究,2017, 21(3):406-411.SHENG X L, YUAN F, LI Z D, et al. Comparison of the accuracy oflower cervical anterior transpedicular screws between three-dimensional printing assembly navigation template and free handplacement[J]. Journal of Clinical Rehabilitative Tissue EngineeringResearch, 2017, 21(3):406-411.
[10]朱文艺,海涌,李健,等.多元化教学方式在骨科临床教学中的应用研究[J].中国病案, 2015, 16(4):87-89.ZHU W Y, HAI Y, LI J, et al. Applied research of diversifiedteaching methods in orthopaedic clinical teaching[J]. ChineseMedical Record, 2015, 16(4):87-89.
[11]PUJOL S, BALDWIN M, NASSIRI J, et al. Using 3D modelingtechniques to enhance teaching of difficult anatomical concepts[J].Acad Radiol, 2016, 23(4):507-516.
[12]李忠海,唐家广,王华东,等. 3D打印技术在骨科临床教学中的应用初探[J].中国医学教育技术, 2016, 30(2):198-200.LI Z H, TANG J G, WANG H D, et al. Exploration of 3D printingtechnology applied in orthopedic clinical teaching[J]. China MedicalEducation Technology, 2016, 30(2):198-200.
[13]EISENMENGER L B, WIGGINS R H, FULTS D W, et al. Applicationof 3D printing in a case of osteogenesis imperfecta for patienteducation, anatomic understanding, preoperative planning, andintraoperative evaluation[J]. World Neurosurg, 2017, 107:1049.
[14]廖政文,莫诒向,张国栋,等. 3D打印个性化康复矫形器的设计制作[J].中国医学物理学杂志, 2018, 35(4):470-477.LIAO Z W, MO Y X, ZHANG G D, et al. Design and development ofthree-dimensional printing personalized rehabilitation orthosis[J].Chinese Journal of Medical Physics, 2018, 35(4):470-477.
[15]陆亮亮,史廷春,于云,等. 3D打印指骨骨折支具的研究[J].航天医学与医学工程, 2017, 30(4):263-269.LU L L, SHI Y C, YU Y, et al. Study on 3D printed brace forphalangeal fractures[J]. Space Medicine&Medical Engineering,2017, 30(4):263-269.
[16]MOK S W, NIZAK R, FU S C, et al. From the printer:potential ofthree-dimensional printing for orthopaedic applications[J]. J OrthopTranslat, 2016, 6(C):42-49.
[17]刘忠军.金属3D打印骨科内植物的应用现状与发展趋势浅析[J].骨科临床与研究杂志, 2017, 2(2):65-67.LIU Z J. Application and development trend of metallic 3D printingplants in orthopaedics[J]. The Journal of Orthopaedic Clinical andResearch Studies, 2017, 2(2):65-67.
[18]黄淦,禹宝庆,敖荣广,等. 3D打印结合定制钢板内固定技术在骨盆骨折治疗中的应用[J].中华创伤杂志, 2016, 32(12):1060-1066.HUANG G, YU B Q, AO R G, et al. Application of three-dimensionalprinting combined with individualized custom-made plate in internalfixation of pelvic fractures[J]. Chinese Journal of Trauma, 2016, 32(12):1060-1066.
[19]CUI H, NOWICKI M, FISHER J P, et al. 3D bioprinting for organregeneration[J]. Adv Healthc Mater, 2016, 6(1):1601118.
[20]WANG C, ZHAO Q, WANG M. Cryogenic 3D printing for producinghierarchical porous and rh BMP-2-loaded Ca-P/PLLA nanocompositescaffolds for bone tissue engineering[J]. Biofabrication, 2017, 9(2):025031.
[21]张明,赖毓霄,王新峦,等.基于3D打印技术的新型生物活性复合镁骨修复支架[J].国际骨科学杂志, 2015, 36(5):382-384.ZHANG M, LAI Y X, WANG X L, et al. A novel bioactive magnesiumbone repair scaffold based on 3 D printing technology[J].InternationalJournal of Orthopaedics, 2015, 36(5):382-384.
[22]郭鹏年,董乐乐,左强,等. 3D打印技术在创伤骨科中的临床应用[J].中国数字医学, 2015, 10(6):45-47.GUO P N, DONG L L, ZUO Q, et al.The clinical application of 3Dprinting technique in trauma orthopedics[J]. China Digital Medicine,2015, 10(6):45-47.
[23]冯均伟,王跃,朱宗,等.骨科人工关节置换术后金属过敏研究进展[J].实用医院临床杂志, 2012, 9(3):166-169.FENG J W, WANG Y, ZHU Z, et al. Research progress in metal allergyafter prosthetic replacement of joint in orthopedics department[J].Practical Journal of Clinical Medicine, 2012, 9(3):166-169.
[24]SEITZ H, RIEDER W, IRSEN S, et al. Three-dimensional printing ofporous ceramic scaffolds for bone tissue engineering[J]. J BiomedMater Res B Appl Biomater, 2005, 74(2):782-788.
[25]张海峰,杜子婧,毛曦媛,等. 3D打印PLA-HA复合材料构建组织工程骨的实验研究[J].国际骨科学杂志, 2016, 37(1):57-63.ZHANG H F, DU Z J, MAO X Y, et al. Experimental reserarch ofconstructing tissue engineered bone using three-dimensional printedpolylactic acid-hydroxyapatite composite scaffolds[J]. InternationalJournal of Orthopaedics, 2016, 37(1):57-63.
[26]XIE P, OUYANG H, DENG Y, et al. Comparison of conventionalreconstruction plate versus direct metal laser sintering plate:an in vitromechanical characteristics study[J]. J Orthop Surg Res, 2017, 12(1):128.