3D打印PEEK材料血管外支架建模及制作方法的可行性和有效性

目的 证明用于治疗胡桃夹综合征的3D打印聚醚醚酮（PEEK）材料血管外支架的三维建模和制作方法的可行性和有效性。 方法 以37例胡桃夹综合征患者为对象,利用患者的CT影像数据,分别对左肾静脉（LRV）受压迫处的动脉和静脉部分进行三维重建并进行3D打印。根据患者动静脉三维数字模型设计血管外支架,并利用PEEK材料进行3D打印。将3D打印PEEK材料血管外支架在1:1动静脉模型上模拟置入并进行术前规划。利用T检验对比分析患者术前和术后3个月的复查数据。 结果 术前CT影像上测得LRV狭窄处直径均值为（2.81 ± 1.67） mm,动静脉三维数字模型上测得其均值为（2.85 ± 1.59）mm,误差绝对值为（0.17 ± 0.21）mm。患者术前与术后3个月复查结果显示,LRV狭窄处直径（P < 0.01）、LRV肾门处直径与狭窄处比值（P < 0.01）以及LRV肾门处血流速度（P ＜ 0.05）均有显著性差异。37位患者术后均无并发症,其中有22位症状完全消失,15位症状明显缓解。CT影像显示支架位置稳定,无移位。 结论 用于治疗胡桃夹综合征的3D打印PEEK材料血管外支架的建模及制作程序可行且有效。     

3D打印心脏模型辅助肺动脉分支狭窄支架置入1例

1临床资料患儿男,7岁10个月。因“法洛四联症纠治术后7年余,气促1个月”于2017年7月2日收入深圳市儿童医院心血管内科。患儿在5个月龄时行法洛四联症纠治术+房间隔修补术+动脉导管缝扎术,术后仍发绀,反复浮肿、腹胀。超声心动图提示肺动脉远端中度狭窄。于1岁9个月时行右心室流出道扩宽术,效果仍欠佳。     

3D打印材料聚醚醚酮支架在耳廓再造中的应用前景

3D打印材料聚醚醚酮(PEEK)是一种在医学领域有许多潜在用途的聚合物,随着3D打印技术的逐渐兴起,不仅能针对患者的病情需求打印出个性化植入,而且PEEK具备作为植入物的必备性能,这两大优点表明其在耳廓的修复与重建领域中有望替代传统修复材料.该文对3D打印材料PEEK作为植入物所具备的优良性能,以及在耳廓再造领域的应用...     

3D打印模型在泌尿外科血管相关性疾病教学中的应用探讨

评价3D打印模型在泌尿外科血管相关性疾病（胡桃夹综合征、腔静脉后输尿管）教学中的应用效果，探讨其可行性与有效性。将实习学员随机分为两组，分别采用传统教学法（对照组）和结合3D打印模型的教学法（试验组）进行教学，以理论和实践考核进行对比，并对结合3D打印模型的教学模式满意度予以问卷调查测评。试验组考核成绩优于对照组（P<0.05）。试验组问卷调查教学模式满意度的结果显示，96.67%的学生对结合3D打印模型的教学模式的总体评价是满意的。3D打印模型在泌尿外科血管相关性疾病教学中的应用，可以直观展示疾病模型，有助于加深学生对相关知识的理解、记忆，能够提高教学质量，是一种有效的教学方法。     

多层螺旋CT对胡桃夹综合征的诊断价值及临床意义

目的利用多层螺旋CT探讨正常人及胡桃夹综合征(NCS)患者肠系膜上动脉(SMA)与腹主动脉(AA)相关解剖对左。肾静脉(LRV)的影响。方法选取经临床和相关检查诊断为NCS的10例(病例组)与29例正常。肾血管者(正常对照组)分别按性别分组和按年龄分组(≤40岁为Ⅰ组,40岁为Ⅱ组),分别观察LRV及其属支的形态、走行位置以及与邻近结构的关系;矢状面或斜矢状面测量SMA与AA的夹角α、夹角问LRV横截面积S;横断面测量SMA和AA间隙内LRV管径D1与近肾侧LRV最大管径D2,并计算D2与D1的比值Q。结果 (1)病变组中LRV均明显扩张,4例合并十二指肠淤滞征,6例合并侧支循环形成;(2)病变组与正常组α的Q、S值分别为20.60±5.79、56.17±17.20;3.67±1.34、1.46±0.29;30.93±14.62. 92.92±39.93,两组差异有统计学意义(P0.01);(3)正常对照组不同性别及不同年龄组中各测量值差异无统计学显著意义(P0.05)。结论利用MSCT能精细测量SMA与AA夹角等相关解剖数据,能判断LRV狭窄的程度,为诊断和治疗NCS提供了一种新的无创性检查方法。     

应用3D打印技术辅助治疗老年复杂肱骨近端骨折的疗效

目的探讨3D打印技术辅助治疗老年复杂肱骨近端骨折的临床应用效果。方法老年复杂肱骨近端骨折患者64例,采用随机数字表法分为实验组和对照组各32例,两组均给予常规治疗,实验组用3D打印技术辅助治疗,比较两组临床相关指标,随访12个月,并采用Neer肩关节评分法(Neer评分)和CMS肩关节评分系统(CMS评分)评价术后肩关节功能。结果手术后X线片可见内固定状况良好,与对照组相比,实验组内固定过程中手术时间、出血量、内固定后引流量及骨折愈合时间均小于对照组(P<0.05)。手术结束后随访12个月,实验组Neer评分的优良率高于对照组(P<0.05);两组术前CMS各项(疼痛、肌力、日常活动、关节活动范围)评分及总分比较差异无统计学意义(P>0.05),治疗后两组各项评分及总分均有改善,且实验组改善更明显(P<0.05)。结论应用3D打印技术辅助治疗老年复杂肱骨近端骨折能够减少手术时间、出血量、内固定后引流量及骨折愈合时间,改善肩关节活动功能,提高了手术质量。     

基于3D打印技术的个性化主动脉覆膜支架的动物实验研究

目的:验证3D打印技术制作个性化主动脉覆膜支架及改良输送系统的可行性。方法:6只实验用猪随机分为2组:个性化支架组(n=3)和标准化支架组(n=3),获取主动脉CT血管造影图像并用3D打印技术制作个性化及标准化直筒型主动脉覆膜支架,同时制作相匹配的输送系统并完成支架腔内精准置入后分别测量主动脉各位置血压,术后1个月复查造影,并处死实验动物行病理检查。结果:个性化支架组均无移位及内漏,标准化支架组1只实验猪发生不可纠正的I型内漏。两组实验猪支架术后主动脉各位置血压差异无统计学意义(P>0.05)。病理结果未见两组实验猪血管内膜损伤。结论:3D打印技术制作个性化主动脉覆膜支架及改良输送系统进行降主动脉扩张性疾病腔内治疗在技术上可行。     

3D打印技术辅助治疗复杂胫骨平台骨折的疗效分析

目的观察3D打印技术辅助治疗复杂胫骨平台骨折的临床效果。方法选2013-07~2016-05期间收治的38例复杂胫骨平台骨折患者为研究对象,所有患者均为新鲜闭合性骨折,Schazker分型为Ⅴ、Ⅵ型。将患者随机分为两组,试验组和对照组各19例。试验组术前使用Mimics软件处理骨折CT扫描数据后打印与实体1∶1大小的胫骨平台骨模型,根据骨模型选择合适的手术入路、复位方法及内固定物。对照组行传统切开复位内固定术。分别记录两组手术时间、术中出血量及术后1年美国特种外科医院膝关节评分(The Hospital for Specical Surgery Knee-ralting Score,HSS)、健康调查简表(The MOS item short from health survey,SF-36)评分。结果 38例患者随访时间均超过1年,手术切口均甲级愈合,骨折愈合时间10~16(14.5±2.1)周。试验组与对照组手术时间分别为(82.4±11.2)min、(126.5±9.1)min;术中出血量分别为(88±39)ml、(302±49)ml,试验组与对照组相比手术时间短,出血量少,差异有统计学意义(P0.05);试验组与对照组术后1年HSS评分为(91.3±2.8)分、(90.1±3.6)分;SF-36评分(89.1±5.6)分、(90.7±7.8)分,两组对比差异无统计学意义(P0.05)。结论 3D打印技术辅助治疗复杂胫骨平台骨折可大大缩短手术时间,减少术中出血量,术后膝关节功能恢复好。     

3D 打印聚己内酯多级管道支架促进梗死后心肌修复

目的:探讨聚己内酯(PCL)多级管道支架对SD大鼠梗死后心肌修复的作用及潜在机制。方法:通过3D打印技术,制备PCL多级管道支架,选取体质量为200～250 g的SD大鼠24只,随机分为3组,分别为假手术组(Sham组)、急性心肌梗死组(MI组)以及治疗组(MI+scaffold组)。采用Masson染色,评价术后28 d各组SD大鼠纤维化程度及心梗面积大小;通过免疫荧光染色,评价术后28 d各组心肌梗死交界区和支架内部血管再生情况。结果:3D打印成功制备PCL多级管道支架;Masson染色表明,术后28 d MI组心肌梗死范围和瘢痕面积明显大于MI+scaftold组[(64.63±7.72)%对(42.01±8.68)%,P0.01;(13.85±1.98)mm~2对(9.82±1.47)mm~2,P0.01];免疫荧光染色表明,术后28 d MI+scaffold组心肌梗死交界区域心肌再血管化程度明显高于MI组[(15±3.13)个/HPF对(5.29±0.91)个/HPF,P0.01], MI+scaffold组补片内部血管化程度高于心肌梗死交界区[(17.7±2.71)个/HPF对(15±3.13)个/HPF,P0.05]。结论:3D打印PCL多级管道支架通过缩小SD大鼠心肌梗死范围及瘢痕区域,促进心肌再血管化来修复心肌。     

经右心房引导支架置入治疗布加综合征一例

1临床资料 患者,男性,38岁,2008年1月因“反复双下肢水肿1年,全身乏力、纳差2个月”来我院就诊。彩超示：下腔静脉穿膈处内径约0．32cm,穿膈处血流明显变细,周围大量侧支血管形成。入院诊断为布加综合征。在我科行非体外循环肝素化布加综合征根治术,手术顺利。     

Transcatheter double stent implantation for treatment of middle aortic coarctation syndrome

A 13‐year‐old boy presented with severe systemic hypertension. His upper limb blood pressure measured 190/100 mm Hg and lower limb blood pressure measured 98/64 mm Hg. The brachial pulses were bounding and femoral pulses were not palpable. Echocardiography and magnetic resonance angiography confirmed middle aortic syndrome. There was severe diffuse thoraco‐abdominal coarctation with continuous Doppler run‐off. Cardiac catheterization was undertaken and using a retrograde approach two Advanta V12 stents were implanted in the complex thoraco‐abdominal coarctation. The gradient across the coarctation was reduced from 80 to 40 mm Hg gradient with a significant improvement in the luminal diameter of the aorta. His upper limb blood pressure reduced to 142/78 mm Hg six weeks later. © 2013 Wiley Periodicals, Inc.     

Sirolimus-eluting stent implantation for unprotected left main coronary artery stenosis: comparison with bare metal stent implantation

OBJECTIVES: This study was designed to compare the clinical and angiographic outcomes of sirolimus-eluting stent (SES) and bare metal stent (BMS) implantation for unprotected left main coronary artery (LMCA) stenosis. BACKGROUND: The safety and effectiveness of SES implantation for unprotected LMCA stenosis have not been ascertained. METHODS: Elective SES implantation for de novo unprotected LMCA stenosis was performed in 102 consecutive patients with preserved left ventricular function from March 2003 to March 2004. Data from this group were compared to those from 121 patients treated with BMS during the preceding two years. RESULTS: Compared to the BMS group, the SES group received more direct stenting, had fewer debulking atherectomies, had a greater number of stents, had more segments stented, and underwent more bifurcation stenting. The procedural success rate was 100% for both groups. There were no incidents of death, stent thrombosis, Q-wave myocardial infarction (MI), or emergent bypass surgery during hospitalization in either group. Despite less acute gain (2.06 +/- 0.56 mm vs. 2.73 +/- 0.73 mm, p < 0.001) in the SES group, SES patients showed a lower late lumen loss (0.05 +/- 0.57 mm vs. 1.27 +/- 0.90 mm, p < 0.001) and a lower six-month angiographic restenosis rate (7.0% vs. 30.3%, p < 0.001) versus the BMS group. At 12 months, the rate of freedom from death, MI, and target lesion revascularization was 98.0 +/- 1.4% in the SES group and 81.4 +/- 3.7% in the BMS group (p = 0.0003). CONCLUSIONS: Sirolimus-eluting stent implantation for unprotected LMCA stenosis appears safe with regard to acute and midterm complications and is more effective in preventing restenosis compared to BMS implantation.     

Initial and long term outcomes of stent implantation for iliac compression syndrome

OBJECTIVES: The initial and long term outcome of stenting in the iliac vein were investigated in patients with iliac compression syndrome. METHODS: Iliac compression syndrome was diagnosed with venography and intravascular ultrasonography that demonstrated severe stenosis at the iliac venous compression site. Fourteen patients with symptomatic iliac compression syndrome were treated with stent implantation. The patency of the stents was examined at short and long term follow-up examinations. RESULTS: Thirteen patients presented with left iliac venous compression and only one patient presented with right iliac venous compression. Twelve of the 14 patients had acute deep venous thrombosis, so temporary vena cava filter implantation was performed during the procedure in these 12 patients. Procedural success was defined as less than 50% stenosis after stent implantation with good flow and without major complication (death, surgical repair for vein, or symptomatic pulmonary embolization). Procedural success was achieved in 13 of 14 patients, and these 13 patients showed improvement of symptoms. In the unsuccessful case, the compression site was resolved by stenting, but good flow was not obtained due to remaining femoral vein occlusion. The self-expandable stent was used for 6 patients, and the balloon-expandable stent was used for 8 patients. Angiographic or ultrasonographic follow up was performed in 10 patients at mean follow up of 8 months, but no restenosis was documented. CONCLUSIONS: Stent implantation for symptomatic iliac compression syndrome is a safe and effective procedure to resolve venous disease symptoms. Despite the small number of patients, long term outcome has been excellent in this study.     

CT guidance ~(125)I seed implantation for pelvic recurrent rectal cancer assisted by 3D printing individual non-coplanar template

正Objective To analyze the difference of dosimetric parameters between pre-plan and post-plan of ~(125)I radioactive seed implantation assisted by 3D printing individual non-coplanar template(3D printing template)for locally recurrent rectal cancer(LRRC).Methods From February 2016 to April 2016,a total of 10 patients with locally recurrent rectal cancer received ~(125)I seeds implan-     

Late thrombosis after bare metal stent implantation in a patient with acute coronary syndrome

We present a case of a 47-year-old man with ST-segment-elevation myocardial infarction (STEMI), successfully treated with bare metal stent implantation. After 20 months the patient was readmitted with another episode of STEMI due to in-stent thrombosis following voluntary withdrawal of anti-platelet therapy. The implications of late stent thrombosis after bare metal stent implantation are discussed. We compare this phenomenon with thrombosis after implantation of drug-eluting stents. Various aspects and potential causes of late stent thrombosis are reviewed, especially the issues pertaining the use of anti-platelet therapy and duration of this therapy.