Release date: 2018-07-09
"3D printing" will become a key technology for digital manufacturing. It is understood that 3D printing through the technology of photo-curing stereoscopic molding, layered solid manufacturing, etc., in the medical field, especially in orthopedics, can design a personalized reconstruction of the vertebral body according to the needs of patient repair and reconstruction, implanted in the body, and its function reconstruction. Recently, one patient in Guangdong Southern Hospital successfully performed 3D printing biomimetic artificial vertebral body replacement surgery.
Spine tumor causes severe damage to the vertebral body
A 35-year-old male patient, Huang, had symptoms of pain, numbness, weakness, and other symptoms of unexplained lower limbs 5 months ago, and the symptoms gradually worsened and he could only walk slowly. After the relevant examination of the Department of Spinal Orthopaedics of the Southern Hospital of Southern Medical University, the diagnosis was as follows: giant cell tumor of the bone combined with aneurysmal bone cyst, corresponding level of spinal stenosis, compression of the spinal cord, leading to bone destruction of the thoracic 12 vertebral body and its attachment.
It is understood that giant cell tumor of bone is an invasive tumor. Its incidence rate in China is second only to osteochondroma and osteosarcoma, the third in the incidence of bone tumors; the majority of patients with giant cell tumor of bone age between 20 and 40 years old, lesions often occur at the bone end of long bones. Common in the lower end of the femur, the upper end of the humerus and the lower end of the humerus, osteolytic, rare on the spine. Aneurysmal bone cyst, also known as benign bone aneurysm, is an invasive bone lesion; 60% to 75% occurs in the upper end of the femur, vertebral body and attachments, mainly as local swelling and pain, and dyskinesia occurs near the joint. Invasion of the thoracic and lumbar vertebrae can cause pain and lower limb atrophy, incontinence and even paraplegia; most occur in people between the ages of 10 and 20.
Zheng Minghui, deputy director of the Department of Spinal Orthopaedics, Southern Hospital of Southern Medical University, said that giant cell tumors with aneurysmal bone cysts are rare. Tumor destruction of the patient's bone tissue causes the vertebral body strength to decrease, the height of the vertebral body is lost, and then the symptoms of low back pain occur. At the same time, part of the tumor tissue breaks into the spinal canal, causing spinal cord and nerve compression. The patient has lower limb sensation and hypokinesia. Symptoms are progressively worse.
After detailed evaluation and discussion of the general department and related departments, the department developed a surgical treatment plan for total vertebral resection and vertebral body replacement for patients. However, the standard of the existing intraspinal fixation product cannot match the physiological parameters of the patient, and the internal implant is prone to sinking, and then the nail plate system may be broken. To solve this problem, the treatment team decided to create an artificial vertebral body based on the patient's condition.
Designed more than 20 kinds of frame structure
The team built accurate 3D images of the patient's spine based on CT scans of the patient's spine. Based on this image, a personalized implant belonging to the patient is designed and 3D printed. In order to better integrate the personalized artificial vertebral body with the patient's vertebral body, the research team designed more than 20 kinds of load-bearing frame structures, dozens of trabecular bone topology, cylindrical, kidney-shaped, smiley, There are more than 10 kinds of shapes and sizes such as banana type, and there are thousands of combinations.
After hundreds of revisions, simulations, revisions, and test screenings, combined with the patient's single-segment vertebral destruction, and located in the chest 12 (thoracic and lumbar segments), the treatment team chose an integrated structure, 12-faced bone trabecular topology. , original vertebral body, artificial vertebral body with 75% porosity.
It is understood that the treatment team through the patient's preoperative spinal CT, and the application of "reverse shape technology" to obtain the morphology of the adjacent vertebral endplate as the upper and lower sides of the artificial vertebral body, so that the artificial vertebral body and the patient's spinal bone interface completely fit, improve The contact area, the stress of the internal implant and the bone interface are reduced, and the endplate fracture and the artificial vertebral body sinking are reduced or even avoided.
"The strong internal frame structure of the artificial vertebral body can easily carry the upper body weight of the human body through the artificial vertebral body, which not only restores the overall height of the spine, but also improves the overall stability of the spine and reduces the risk of loosening and fracture of the spinal column." Finally, With the joint efforts of the surgical team and the design team, the operation was a complete success, and the patient was free to go to the ground 3 days after surgery.
The entire process can be controlled for two weeks
According to Zheng Minghui, patients with severe damage to the vertebral body caused by spinal tumors and severe burst fractures of the spine are mainly treated with total vertebral resection, which can seriously damage the stability of the spine biomechanics, and all the vertebral bodies are performed. In the resection, it is necessary to reconstruct the stability of the spine, that is, the artificial vertebral body is implanted in the resected vertebral body. The traditional artificial vertebral body is not designed for the individualized design of the patient, but has been designed according to the model machine, size or Mismatch. If the upper and lower sides of the artificial vertebral body are not completely in contact with the vertebral body of the human body, the force is not uniform, and the end plate fracture and internal fixation are prone to sinking, which seriously affects the supporting strength and does not achieve a rational long-term effect. The 3D printing individualized implants for tissue defect repair can greatly improve the accuracy and safety of the surgery.
The 3D printed bionic artificial vertebral body/disc integrated implant has independent intellectual property rights and has reached the international leading level. Zheng Minghui said that through the design of 3D printed bionic artificial vertebral body, the team explored a set of optimization process, which can control the patient's acquired vertebral body parameters from the beginning of the patient to the final personalized 3D printing bionic artificial vertebral body completion control in about two weeks. (Special correspondent He Liping correspondent Li Xiaotong)
Source: Health News
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