Author: Correspondent Li Shan Ren Ng Release Date: 2018-07-02
Currently, 3D printing technology is in the ascendant. In the medical field, especially in orthopedics, individualized vertebral bodies can be designed according to the needs of patients, re-implanted into the body, functional reconstruction and the function of the desired part. A few days ago, Nanfang Hospital of Southern Medical University successfully performed a 3D printed bionic artificial vertebral body replacement surgery for a patient.
The 35-year-old Huang from Chaoyang is a fisherman and the main labor force in the family. However, five months ago, he had unexplained pain, numbness, weakness and other symptoms in his lower extremities, and his symptoms gradually increased and he could only walk slowly. After the related examination of the Department of Spinal Orthopaedics of the Southern Hospital of Southern Medical University, it was diagnosed as giant cell tumor with aneurysmal bone cyst, corresponding to the spinal canal stenosis, compression of the spinal cord, resulting in destruction of the thoracic 12 vertebral body and its attachment.
It is understood that giant cell tumor of bone is an invasive tumor, also known as osteoclastoma. It is the third largest bone tumor in China. Aneurysmal bone cyst, also known as benign bone aneurysm, has invasive bone lesions. 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 of Huang's condition by various departments of the hospital, it is believed that the surgical indications are clear, and a vertebral body invaded by the tumor should be subjected to total vertebral body resection and vertebral body replacement. However, the criteria for existing spinal fixation products do not match the patient's physiological parameters, and are prone to sinking of the internal implant, which in turn may cause the nail plate system to break. In order to solve this problem, the treatment team decided to make an artificial vertebral body for him according to the patient's condition.
Based on the CT scan data of the patient's spine, the research team created accurate 3D images of Hwang's spine. Based on this image, a personalized implant belonging to Hwang was designed and 3D printed. After hundreds of revisions, simulations, and revisions, after testing and screening, 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. Structure, original vertebral body, artificial vertebral body with 75% porosity.
"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. It is possible to go to the ground as soon as possible and even enter normal life.†Finally, with the joint efforts of the surgery team and the design team, the operation was a complete success, and Huang could freely move to the ground after 3 days.
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. However, this kind of surgery will seriously destabilize the biomechanics of the spine. Anyone who has undergone total vertebral resection needs to reconstruct the stability of the spine, that is, implant the artificial vertebral body at the resected vertebral body. However, the traditional artificial vertebral body is not designed for the patient's individual design, but has been designed and manufactured according to the model machine, and the size matching is not suitable. The upper and lower sides of the artificial vertebral body cannot fully contact the vertebral body of the human body, and the force is uneven. It is prone to endplate fracture, internal fixation and sinking, which seriously affects the support strength. It does not reach the rational long-term effect. Sometimes it needs to be operated again. Because of scar growth during reoperation, the operation is very difficult and the risk is high.
3D printing of individualized implants for tissue defect repair can greatly improve the accuracy and safety of surgery.
Zheng Minghui said that through the design of 3D printed bionic artificial vertebral body, the team explored a set of optimization process. At present, it can start from the patient's acquisition of the diseased vertebral body parameters, and finally control the completion of the personalized 3D printing bionic artificial vertebral body in about 2 weeks.
Source: Guangzhou Daily
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