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OBJECTIVE@#To explore the effectiveness of a new point contact pedicle navigation template (referred to as "new navigation template" for simplicity) in assisting screw implantation in scoliosis correction surgery.@*METHODS@#Twenty-five patients with scoliosis, who met the selection criteria between February 2020 and February 2023, were selected as the trial group. During the scoliosis correction surgery, the three-dimensional printed new navigation template was used to assist in screw implantation. Fifty patients who had undergone screw implantation with traditional free-hand implantation technique between February 2019 and February 2023 were matched according to the inclusion and exclusion criteria as the control group. There was no significant difference between the two groups ( P>0.05) in terms of gender, age, disease duration, Cobb angle on the coronal plane of the main curve, Cobb angle at the Bending position of the main curve, the position of the apical vertebrae of the main curve, and the number of vertebrae with the pedicle diameter lower than 50%/75% of the national average, and the number of patients whose apical vertebrae rotation exceeded 40°. The number of fused vertebrae, the number of pedicle screws, the time of pedicle screw implantation, implant bleeding, fluoroscopy frequency, and manual diversion frequency were compared between the two groups. The occurrence of implant complications was observed. Based on the X-ray films at 2 weeks after operation, the pedicle screw grading was recorded, the accuracy of the implant and the main curvature correction rate were calculated.@*RESULTS@#Both groups successfully completed the surgeries. Among them, the trial group implanted 267 screws and fused 177 vertebrae; the control group implanted 523 screws and fused 358 vertebrae. There was no significant difference between the two groups ( P>0.05) in terms of the number of fused vertebrae, the number of pedicle screws, the pedicle screw grading and accuracy, and the main curvature correction rate. However, the time of pedicle screw implantation, implant bleeding, fluoroscopy frequency, and manual diversion frequency were significantly lower in trial group than in control group ( P<0.05). There was no complications related to screws implantation during or after operation in the two groups.@*CONCLUSION@#The new navigation template is suitable for all kinds of deformed vertebral lamina and articular process, which not only improves the accuracy of screw implantation, but also reduces the difficulty of operation, shortens the operation time, and reduces intraoperative bleeding.
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Humans , Orthopedic Procedures , Pedicle Screws , Retrospective Studies , Scoliosis/surgery , Spinal Fusion/methods , Spine , Surgery, Computer-Assisted/methodsABSTRACT
Pelvic and acetabular fractures are one of the serious traumatic diseases, leading to a high rate of disability and fatality. Their operative principles are anatomical repositioning and rigid fixation to achieve early functional exercise and avoid complications. The updating modern technology has made precision and minimally invasion a trend in orthopedic surgery. An increasingly number of new technologies has been applied in clinical surgery, such as three-dimensional printing, three-dimensional navigation, and orthopedic robotics, each with its own characteristics. Of them, three-dimensional printing technology is more advantageous in terms of reducing surgical cost and risk, enhancing surgical efficiency, achieving surgical precision and reducing radiation exposure, as evidenced by a large number of clinical case reports and randomized controlled trials. This paper summarizes the current situation and assesses the prospects of three-dimensional printing technology in the diagnosis and treatment of pelvic and acetabular fractures in order to provide reference for orthopedic colleagues.
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Objective:To explore the short-term outcomes of reconstruction of tumorous critical bone defects at femoral shaft with a 3D printed ultra-short stem with a porous structure.Methods:From September 2016 to June 2018, 8 patients underwent reconstruction of critical bone defects with a 3D printed ultra-short stem with a porous structure after resection of femoral shaft malignant tumor at Department of Orthopaedics, West China Hospital. There were 4 males and 4 females, with an average age of 36.9 years (from 11 to 61 years). Their preoperative Enneking staging was stage Ⅱb in all. There were 3 osteosarcomas, 2 Ewing sarcomas, 2 chondrosarcomas and one periosteal osteosarcoma. Preoperative CT/MRI image fusion technology was used to define the surgical boundary, design the guide plate and prosthesis, and perform surgical simulation. Tomosynthesis-shimadzu Metal Artefact Reduction technology was used to evaluate osseointegration. Complications and bone oncology prognosis of the patients were documented. The lower limb function of the patients was evaluated using Musculoskeletal Tumor Society (MSTS) 1993 scoring and knee range of motion.Results:The overall follow-up time ranged from 36 to 50 months, averaging 42.8 months. During operation one patient sustained a periprosthesis fracture, the union of which was followed up after wire assisted fixation. There was no local tumor recurrence, lung metastasis or death. The last follow-up revealed good osseointegration and basically isometric lower extremities in all cases. There was no such a complication as aseptic loosening of the prosthesis, deep infection or prosthesis fracture during the follow-up period. At the last follow-up in the 8 patients, the flexion range of the knee joint was 116.2°±9.1°, significantly improved compared with that before operation (98.8°±10.9°), and the MSTS score was (26.2±2.1) points, also significantly improved compared with that before operation [(21.6±1.8) points] ( P<0.05). Conclusions:Reconstruction with a 3D printed ultra-short stem with a porous structure is an accurate operation for femoral shaft tumorous bone defects. With careful preoperative design, intraoperative manipulation and strict postoperative follow-up management, this operation can lead to fine early curative outcomes for long shaft critical bone defects.
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Three-dimensional printing is a technology that prints the products layer-by-layer, in which materials are deposited according to the digital model designed by computer aided design (CAD) software. This technology has competitive advantages regarding product design complexity, product personalization, and on-demand manufacturing. The emergence of 3D technology provides innovative strategies and new ways to develop novel drug delivery systems. This review summarizes the application of 3D printing technologies in the pharmaceutical field, with an emphasis on the advantages of 3D printing technologies for achieving rapid drug delivery, personalized drug delivery, compound drug delivery and customized drug delivery. In addition, this article illustrates the limitations and challenges of 3D printing technologies in the field of pharmaceutical formulation development.
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Spinal fusion is a standard operation for treating moderate and severe intervertebral disc diseases. In recent years, the proportion of three-dimensional printing interbody fusion cage in spinal fusion surgery has gradually increased. In this paper, the research progress of molding technology and materials used in three-dimensional printing interbody fusion cage at present is summarized. Then, according to structure layout, three-dimensional printing interbody fusion cages are classified into five types: solid-porous-solid (SPS) type, solid-porous-frame (SPF) type, frame-porous-frame (FPF) type, whole porous cage (WPC) type and others. The optimization process of three-dimensional printing interbody fusion cage and the advantages and disadvantages of each type are analyzed and summarized in depth. The clinical application of various types of 3D printed interbody fusion cage was introduced and summarized later. Lastly, combined with the latest research progress and achievements, the future research direction of three-dimensional printing interbody fusion cage in molding technology, application materials and coating materials is prospected in order to provide some reference for scholars engaged in interbody fusion cage research and application.
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Humans , Intervertebral Disc Degeneration , Intervertebral Disc Displacement , Porosity , Printing, Three-Dimensional , Spinal FusionABSTRACT
BACKGROUND: Application of three-dimensional printing technology provides an effective supplementary means for minimally invasive and individualized surgery of posterior column fracture of tibial plateau. OBJECTIVE: To summarize the present situation of diagnosis and treatment of posterior column fracture of tibial plateau, and to look forward to the effect of three-dimensional printing technology in the diagnosis and treatment of posterior column fracture of tibial plateau. METHODS: A computer-based retrieval of CNKI, WanFang, and PubMed databases was conducted using the keywords of “the fracture of tibial plateau, posterior column, 3D printing technology” in Chinese and English, respectively. Totally 210 articles were retrieved, and 56 eligible articles were finally included for review based on inclusion and exclusion criteria. The detailed contents included classification of posterior column fracture of tibial plateau, surgical treatment, application status of three-dimensional printing technology and postoperative rehabilitation. RESULTS AND CONCLUSION: Posterior column fracture of tibial plateau is a special type of plateau fracture, so the traditional method may lead to misdiagnosis. However, the solid model based on three-dimensional printing can directly make diagnosis, and analyze the injury mechanism and classification. In the treatment of posterior column fracture of tibial plateau, there are various traditional surgical approaches to choose: The posterior approach (postmedial approach, posterolateral approach), backward medial inverted “L” into the approach, anterolateral/anterolateral approach, anterolateral posterolateral combined approach, arthroscopy minimally invasive treatment and so on, but have not been unified yet. The application of three-dimensional printing technology has further improved the diagnosis and classification of posterior column fracture of tibial plateau, and provides a reference for preoperative guidance of personalized surgical plan, surgical approach selection, estimation of intraoperative bone implant volume and postoperative rehabilitation.
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Objective To investigate the effect of hydroxyapatite/zirconia (HA/ZrO2) scaffold by three-dimensional printing compounded with vascular endothelial growth factor (VEGF) 165 calcium alginate microsphere slow-release system on repairing femoral shaft defects in dogs.Methods The HA/ZrO2 artificial prosthesis was prepared by three-dimensional printing,and the co-culture system of slow-release system of composite VEGF 165 calcium alginate microspheres was constructed.Sixteen beagle dogs were divided into four groups according to the extent of femoral shaft interception,with four dogs in each group.Group A:no biomaterials were implanted into the middle femur of dogs after 15 mm of femur interception as blank control group;Group B:HA/ZrO2 scaffolds composite with VEGF165 calcium alginate microspheres were implanted into the middle femur of dogs after 15 mm of femur interception;Group C:the same method as Group B was adopted after 25 mm of femur interception;Group D:the same method as Group B was adopted after 35 mm of femur interception.General examination and X-ray imaging observation were taken after operation.The ability of new HA/ZrO2 gradient biocomposites to repair bone defects was evaluated by micro CT scanning,biomechanical testing,ink staining and toluidine blue staining 12 weeks after operation.Results The drug loading capacity of calcium alginate microspheres reached (23.6 ± 2.9) ng/mg,and the entrapment efficiency reached (62.4 ± 3.6) ％,showing a slow rate of release.Gross examination showed surgical incision was healed in all four groups.Postoperative X-ray imaging of experimental animals showed that nonunion was formed in Group A over time;in Group B,the artificial prosthesis was gradually filled with new bone and the boundary was blurred;in Group C,the early reaction was slower than that in Group A,and the callus passed continuously 12 weeks after operation;in Group D,new bone formation was slow,only surrounding the broken end.At 12 weeks after operation,the neonatal bone mass was (238.6 ± 19.1)mm3 in Group B,(223.3 ± 13.4) mm3 in Group C,and (110.8 ± 6.5) mm3 in Group D.There were significant differences among the three groups (P ＜ 0.05),but no significant difference was found between Group B and Group C (P ＞ 0.05).The results limit compression test at 12 weeks after operation showed no significant differences among Groups B [(49.7 ± 2.3) MPa],C [(49.81 ± 2.4) MPa] and D [(46.9 ± 3.6) MPa](P ＞ 0.05).At 12 weeks after operation,the histological sections showed that the blood vessels in Groups B and C were thickened,with obvious branches,and the surrounding new bone increased.During the period,the blood vessels were filled with vascular network.There were no obvious differences in the number and shape of blood vessels between groups.However,Group B had more new bones and blood vessel networks.New bone and small vascular networks were seen in Group D.Conclusion The hydroxyapatite/zirconia scaffold by three-dimensional printing compounded with vascular endothelial growth factor 165 calcium alginate microsphere slow-release system can repair dogs' femoral bone defect within 35 mm.
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With the introduction and development of the concept of precision surgery,3D printing individualized guide template has been gradually applied in the field of spinal surgery because of its advantages of increasing surgical precision,reducing the difficulty and risk of surgery,reducing the operation time,and reducing the intraoperative transmission dose,etc..Individualized guide plates designed and manufactured according to the patient~ surgical site,self-conditions and individual differences before surgery can accurately restore the preoperative design during surgery to meet the needs of modernized spine surgery for individualization and precision.Individualized guide template has great guiding significance for complex spinal surgery.This article reviews the current clinical application of 3D printing individualized guide template in spine surgery,summarizes its produce principles and procedures,advantages and limits,and make prospect for it's future applications.
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Objective: To explore the gait trajectory characteristics of patients after total knee arthroplasty (TKA) assisted by three-dimensional (3D) printing navigation template. Methods: Twenty female patients (20 knees) with knee osteoarthritis who were treated with TKA assisted by 3D printing navigation template between February 2017 and February 2018 were selected as the 3D printing group. The patients were 50-69 years old, with an average age of 57.2 years. The disease duration was 4-7 years, with an average of 5.6 years. The osteoarthritis was classified as Kellgren-Lawrence Ⅲ level in 5 cases and Ⅳ level in 15 cases. The preoperative hip-knee-ankle angle (HKA) was (170.8±5.6)°. All patients were varus deformity. According to age and affected side, 20 healthy female volunteers were selected as the control group. The volunteers were 51-70 years old, with an average age of 56.7 years. Preoperative HKA was (178.8±0.6)°. There was significant difference in HKA between the two groups ( P>0.05). The HKA, Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and visual analogue scale (VAS) scores of the 3D printing group before and after operation were compared. At 6 months after operation, the gait trajectory characteristics of 3D printing group and control group were analyzed by Vicon gait capture system. The kinematics parameters included velocity, cadence, stride length, maximum knee flexion angle (stance), minimum knee flexion angle (stance), maximum knee flexion angle (swing), mean hip rotation angle (stance), mean ankle rotation angle (stance). Results: The incisions of 3D printing group healed by first intention, with no complications. All patients were followed up 7-12 months (mean, 9.0 months). The WOMAC and VAS scores at 6 months after operation were significant lower than those before operation ( P<0.05). The HKA was (178.8±0.8)° at 4 weeks after operation and the difference was significant when compared with that before operation ( t=39.203, P=0.000). The position of the prosthesis was good. The femoral posterior condyle osteotomy line, surgical transepicondylar axis, and patella transverse line were parallel, varus deformity was corrected, and lower limb alignment was restored to neutral position. Gait analysis at 6 months after operation showed that the differences in all kinematics parameters between the two groups were significant ( P<0.05). Conclusion: Assisted by 3D printing navigation template, TKA can alleviate pain symptoms and correct deformity, with satisfactory early effectiveness. Compared with healthy people, the early postoperative gait of the patients were characterized by decreasing velocity, cadence, stride length, knee flexion range, and increasing compensatory hip and ankle rotation range.
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The therapeutic strategies of intracranial aneurysms include surgical clipping and endovascular embolization. Surgical clipping is still challenging for complex aneurysms with various configurations and complicated vasculatures. Endovascular treatment is risky for aneurysms with tortuous routes that make superselections of microcatheter difficult. Three dimensional(3D) printing technology can replicate aneurysm and its related vessels,then help doctors optimize the surgical or endovascular plan preoperatively and provide guidance intraoperatively, thus might improve treatment effects and reduce complications. The progress of 3D printing technique in the treatment of intracranial aneurysms will be reviewed.
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Objective To observe the effects of applying 3D printing technology to interventional neuroradiology teaching so as to evaluate the feasibility and efficiency of the technology.Methods Computed tomography angiography was transformed into three-dimensional images and printed out as the case models. The 3D printed models were used in the teaching for interventional neuroradiology.Results The 3D printed entity model in diseases of the nervous systemnot only helps students deepen the understanding of anatomy and operation process, but also can significantly improve students' learning enthusiasm and help master teaching contents ( <0.05) . Conclusions The 3D print technique based on CT angiography has remarkable effect in the education of interventional neuroradiology.
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Objective: To evaluate the effectiveness of unstable pelvic fractures treated by cannulated screw internal fixation with the assistance of three-dimensional (3D) printing insertion template.
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Results: The scaffolds in 3 groups were all showed a cross-linked and pore interconnected with pore size of 400-500 μm, porosity of 56%, and fiber orientation of 0°/90°. For dopamine modification, the scaffolds in groups B and C were dark brown while in group A was white. Similarly, water static contact angle was from 76° of group A to 0° of groups B and C. After cultured for 24 hours, the cell adhesion rate of groups A, B, and C was 34.3%±3.5%, 48.3%±1.5%, and 57.4%±2.5% respectively, showing significant differences between groups ( P<0.05). Live/Dead staining showed good cell activity of cells in 3 groups. MTT test showed that hBMSCs proliferated well in 3 groups and the absorbance ( A) value was increased with time. The A value in group C was significantly higher than that in groups B and A, and in group B than in group A after cultured for 4, 7, 14, and 21 days, all showing significant differences ( P<0.05). The mRNA relative expression of collagen type Ⅱ and Aggrecan increased gradually with time in 3 groups. The mRNA relative expression of collagen type Ⅱafter cultured for 7, 14, and 21 days, and the mRNA relative expression of Aggrecan after cultured for 14 and 21 days in group C were significantly higher than those in groups A and B, and in group B than in group A, all showing significant differences ( P<0.05).
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Conclusion: Application of 3D printing technology in treatment of internal or external ankle distal avulsed fracture is simple, safe, reliable, and effective. In particular, it is an ideal treatment for avulsed fracture.
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Objective: To explore the feasibility of the repair and reconstruction of large talar lesions with three-dimensional (3D) printed talar components by biomechanical test.
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Objective: To evaluate the effectiveness of total knee arthroplasty (TKA) using three-dimensional (3D) printing technology for knee osteoarthritis (KOA) accompanied with extra-articular deformity.
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Currently,independent clinical medial femoral plate is more needed to apply in more complex C3 distal femoral fractures and knee valgus orthopedic surgery.The doctors always pre-bent the contralateral femoral lateral plate in order to achieve close to the natural shape of the bone.The cold deformation of the plate can change the metallographic structure and the biomechanics,and the position of the screw holes in the plate may also affect the healing of fractures.Compared with traditional manufacturing techniques,3D printing technology as a core technology in third industrial revolution,instead prior manufacture of molds,removing the large amount of material in the manufacturing process and the complex process of forging a final product,it is more suitable for difficult to machine materials,manufacture,inspection shape design,assembly,testing and fast reverse engineering.Therefore,a personalized interior distal femoral plate with 3D printing technology was designed,and the application of the plate,the current situation and prospects of 3D printing technology and other aspects were summarized in this article.
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Objective To study onclinical researches of 3D printing technology in Orthopedics.Methods Through literature search,107 literatures were included and systematically reviewed,and the status of clinical researches of 3D printing technology in orthopedics was described.Results The clinical researches of 3D printing technology in Orthopedics were mainly focused on males and adults population conducted from 2007 to 2012.3D printing technology frequently used in Orthopedics were reduction and internal fixation,deformity correction,pedicle screw placement,tumor resection,revision and reconstruction,and knee replacement.Conclusion 3D printing technology in Orthopedics is still at an initial stage of clinical development.
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Objective To assess the effect of clinical application of three-dimensional printing technology (3D printing) in Orthopedics.Methods Comparing the effect of clinical application of three-dimensional printing technology with traditional Standardized technology,through using a systematic review and Meta Analysis.Results Meta analysis of 25 studies included in the research showed that application of 3D printing reduced operation time by 26 minutes,decreased intraoperative blood loss by 77 ml,and increased accuracy rate or success rate of screw implanting(increased by 2.10 times compared with tradit onal standardized technology).Conclusion The application of 3D printing in Orthopedics has good short-term effect But its deVelopment in clinical application should be cautious.
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Objective To evaluate the safety and efficacy of clinical application of three-dimensional printing technology (3D printing) in Orthopedics.Methods The safety and effectiveness of clinical application of three-dimensional printing technology in Orthopedics were analyzed by systematic review of non-control studies.Results Non-control studies showed that cortical perforation rate of screws was 3.83％ (calculated by the number of screw).Complication rate was 2.13％,surgical infection rate was 0.28％,prosthesis problematic rate was 0.79％,the average operation time was 139.23 minutes,and some results of the indicators for safety and effectiveness were similar between studies with and without control groups.Conclusion Although 3D printing application in Orthopedics has some clinical value,and its extension needs economic assessment.