一群土耳其大学研究美国卫生工程师协会(asse)ssed the viability of using 3D bioprinting technology to enhance success rates in spinal surgery.
By combining CT scanning and 3D bioprinting technologies, the research team was able to rapidly convert anatomical images into a series of guides and 3D models. The novel components could allow for new applications in spinal surgery, including preoperative planning, surgical simulation, and potentially implantable devices.
Additive manufacturing in spinal surgery
Developing a sound knowledge of human anatomy and the ability to identify landmarks during surgery, can involve a steep learning curve, but these are important requirements for proper surgical intervention. According to the researchers, traditional intraoperative techniques such as CT scanning and fluoroscopy-based methods can lead to prolonged surgery duration, radiation exposure, and high costs.
The research team suggests that utilizing haptic sensation rather than 2D images to assess patients, could provide spinal surgeons with more realistic anatomical demonstrations of patients’ deformities. Using this more detailed approach could lead to reductions in surgical duration, blood loss, and fluoroscopy time, as well as costs, by eliminating intraoperative navigation usage in complex spinal procedures.
治疗脊柱畸形的操作通常需要生产准备使用植入物进行前柱重建的手术，从而使拟合度不正确后带来了植入物脱位的风险。3D打印这些零件，使它们具有均匀的负载分布和优质的骨整合，使植入物可以为患者量身定制，并降低并发症的风险。使用此过程产生的“ DP模型”是对患者解剖结构的更准确表示，并且显示出较不常见的解剖结构。
3D打印的核心逐层概念使研究人员能够生成详细的解剖模型，这是不可能使用其他方法，甚至是复杂的铣床。此外，研究人员发现，开始制造需要更少的工业机器，并且需要很少的培训来操作系统。因此，将添加剂制造与雷电竞充值CT扫描技术相结合，可以与外部和内部轮廓几何形状同时生产复杂的模型，这些模型可能与患者解剖结构非常相似。
Additive advances in spinal surgery
Pedicle screw insertion is a common procedure in spinal surgery, but it’s fraught with potentially devastating and life-threatening complicated injuries of the inferior vena cava, descending aorta, spinal cord, and lung. Korean researchers found in 2018, that 3D printing could be used to avert the risks of such complications. In their study, residents with no prior knowledge of the insertion procedures were able to implement the procedure on a 3D printed model. Although the imitations couldn’t fully mimic the texture of real human tissues, the design was found to provide a better representation of anatomy than standard imaging methods and had the potential to improve doctor-patient interactions.
使用3D打印还可以帮助减少螺丝插入手术的并发症，通过帮助外科医生确定椎弓根的入口点，并通过3D打印的指南进行准确的轨迹。雷竞技官网登录根据患者的术前CT扫描或MRI成像，指南布局由与后椎骨结构匹配的部分，以及用于螺钉仪器的概述钻孔轨迹。在操作场景中，将消毒的组件放在目标椎骨的表面上，以纠正椎弓根螺钉方向。
在一项试点研究中，该过程是使用11例患者的3D指南进行的。雷竞技官网登录这些组件实现了术前计划，术中有促进的椎弓根螺钉插入，并且该方法被发现是经济且易于使用的。同样，2019年进行的一项研究使用了一系列15个严重先天性脊柱侧弯患者的3D印刷指南。雷竞技官网登录这些研究人员推测，螺丝插入比最稳定的徒手技术更准确，并向那些无法进入CT扫描仪或O-arm导航的外科医生推荐了指南。雷竞技官网登录此外，遇到了五个异常或变体椎弓根。指导模板的利用帮助外科医生选择了正确的螺钉，并为每个椎弓根选择最理想的螺丝轨迹，以有效地处理变化。
土耳其研究人员得出的结论是，使用3D打印指南会导致患者的安全性提高，使外科医生能够执行更复杂的手术，并能够为骨缺雷竞技官网登录损创建定制的植入物。未来的应用可能是术前计划，外科模拟和术中指导。尽管研究小组承认对基于聚合物的模板生产的碎屑的担忧，但发现钛患者特异性模板可以解决此问题，尽管成本较高。研究人员预计，进一步的研究将继续开发该技术，并找到使用它的脊柱手术的各个方面。
手术添加剂应用
其他各种3D印刷公司已经创新了自己的解决方案，以生产脊柱植入物，其中许多人获得了美国食品和药物管理局（FDA）的批准。
德州医疗设备公司Osseus融合系统获得了FDA批准的白羊座范围3D打印的脊柱植入物2018年8月。使用钛材料生产，白羊座腰椎室内融合装置旨在帮助外科医生缓解背部疼痛并缩短手术后的脊柱恢复时间。
Centinel Spine, a Pennsylvania-based spinal device development company, received clearance from the FDA in June 2018, to market its3D打印植入设备。该公司的FLX平台由全翼型设备组成，这些设备可稳定脊椎中的椎骨，并增加脊柱手术后患者的愈合过程。
Medical firm Emerging Implant Technologies GmbH (EIT) gained FDA approval in January 2018 to produce the “first-ever” 3D printed脊柱植入物治疗多重伤害。使用selective laser melting (SLM) 3D printing allowed EIT to make implants with a core that mimics the cancellous (“spongy”) and cortical (hard) structure of bone.
研究人员的发现在其论文中详细介绍了“3D打印和脊柱手术，”于2020年5月29日在骨科手术杂志。The research was co-authored by Alpaslan Senkoylu, Ismail Daldal, and Mehmet Cetinkaya.
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Featured image shows the silhouette of a woman experiencing pain in her spine. Photo via the Royal Society of Physiotherapy.
