3D打印技术在创伤骨科中的应用进展

随着3D打印技术的不断发展,其在创伤骨科领域中的应用越来越广泛,几乎涵盖了人体所有的解剖区域。3D打印技术也被称为"增材制造技术"和"快速成形技术",被认为是"第二次工业革命"。3D打印技术不仅可以打印出患者特异性的解剖实体模型,便于医师对患者复杂的解剖结构及疾病有更好的理解,同时有助于医学教育和手术培训,而且对于一些特殊患者可以制造定制的植入导板及假体,匹配患者的解剖结构,有效解决临床治疗难题。本文就3D打印技术在创伤骨科中的应用进展进行综述。     

Soft 3D-Printed Phantom of the Human Kidney with Collecting System

Organ models are used for planning and simulation of operations, developing new surgical instruments, and training purposes. There is a substantial demand for in vitro organ phantoms, especially in urological surgery. Animal models and existing simulator systems poorly mimic the detailed morphology and the physical properties of human organs. In this paper, we report a novel fabrication process to make a human kidney phantom with realistic anatomical structures and physical properties. The detailed anatomical structure was directly acquired from high resolution CT data sets of human cadaveric kidneys. The soft phantoms were constructed using a novel technique that combines 3D wax printing and polymer molding. Anatomical details and material properties of the phantoms were validated in detail by CT scan, ultrasound, and endoscopy. CT reconstruction, ultrasound examination, and endoscopy showed that the designed phantom mimics a real kidney’s detailed anatomy and correctly corresponds to the targeted human cadaver’s upper urinary tract. Soft materials with a tensile modulus of 0.8–1.5 MPa as well as biocompatible hydrogels were used to mimic human kidney tissues. We developed a method of constructing 3D organ models from medical imaging data using a 3D wax printing and molding process. This method is cost-effective means for obtaining a reproducible and robust model suitable for surgical simulation and training purposes.     

3D打印技术在骨肿瘤精准化治疗中的研究进展*

骨肿瘤的手术治疗包括肿瘤切除和功能重建两部分,传统手术方式往往存在各种局限性。3D打印技术作为一种新兴的技术,在术前规划、肿瘤切除和功能重建中发挥了重要作用,同时在多种骨科数字技术的辅助下,成功实现了骨肿瘤的精准化治疗。此外,3D生物打印也在骨肿瘤的治疗中展现了巨大潜力。本文总结回顾了3D打印技术在骨肿瘤治疗中的应用情况及研究进展,并分析了现有技术的优缺点,发现3D打印技术在临床治疗中具有独特的优势,在骨肿瘤精准化治疗中具有广泛的应用前景。     

光固化3D打印软组织材料的性能研究进展

光固化3D打印技术具有成型速度快、精度高的特点,可以精确控制需打印软组织的大小、形状和强度等,完成所需替代软组织支架的高匹配定制,有效解决软组织替代物的巨大缺口。目前该技术的应用范围取决于光敏材料的性能,首先,需具备适当的黏度、固化时间和固化收缩率等,以执行光固化打印并能控制打印组织的精度;其次,打印组织还需满足机体使用的机械性能(如强度、硬度、韧性)和良好的生物相容性(如促细胞黏附、增殖及分化),而降解性质、孔隙率、血管化等直接影响打印组织的机械性能或生物相容性。综述软组织支架打印所需光敏材料的基本性能和特殊性能要求及目前改良材料性能的方法,并展望光敏材料的发展趋势,对软组织工程光敏打印材料的开发具有指导意义。     

颅骨修补材料研究现状及3D打印技术应用前景

BACKGROUND: Skull repair materials cannot only restore the normal shape of the skull, but also play an important role in brain functional recovery. OBJECTIVE: To summarize the research status of polyetheretherketone (PEEK), titanium alloy and tissue engineering technique in cranioplasty and the prospect of three-dimensional (3D) printing technology. METHODS: Literatures related to skull repair materials were retrieved in databases of CNKI and PubMed published from 1995 to 2016, using the keywords of “bone regeneration material in calvarial, 3d printing bone scaffold” in Chinese and English, respectively.  RESULTS AND CONCLUSION: Although titanium and PEEK have been used in clinic, titanium holds conductivity, thermal conductivity, while PEEK that may be displaced or lost is not involved in osseointegration. Tissue engineering technology participates in the skull tissue reconstruction, achieving satisfactory repair outcomes, but the problems of scaffold selection and preparation, seed cell obtainment, and growth factor release need to be overcomed. 3D printing technology can print personalized shape, fit the defect precisely, but the raw materials should have good biocompatibility and biomechanical property. Combination of tissue engineering technology with 3D printing technology shows a broad prospect in cranioplasty.     

男性盆腔器官群实体模型的研制与实验研究

目的 在前列腺穿刺手术中,穿刺针和组织器官的变形会对手术精度产生很大影响.因此深入的穿刺实验研究和大量的手术训练对于提高手术治疗效果十分必要.为了便于实验研究及手术训练的开展,笔者研制了男性盆腔器官群实体模型,并进行了相应的实验研究.方法 根据人体核磁共振扫描图像进行盆腔器官群三维重建后,设计单体器官模具.采用一种新型聚乙烯醇(PVA)水凝胶,通过调整其成分配比及制作工艺得到满足不同组织生物力学特性的仿生材料,分别制作相应的单体器官模型;将单体器官依据人体解剖学结构进行装配,并模拟人体盆腔内环境;最后以制作完成的器官群模型进行穿刺力和穿刺变形实验.结果 穿刺力实验数据表明此模型对器官群模型的力学特性符合实际手术中穿刺力的变化规律.穿刺变形实验中,通过超声图像可清晰显示出穿刺针和组织器官的形变,说明器官群模型具有较好的超声成像效果.结论 男性盆腔器官群实体模型能够满足穿刺实验研究以及穿刺手术训练的需求,可为进一步提高穿刺手术的精度及穿刺手术的推广奠定基础.     

三维打印技术在骨组织工程领域的应用研究进展

综述了三维(3D)打印技术的出现、分类与优势等.介绍了该技术在骨组织工程领域的应用,包括光固化立体印刷、熔融沉积成型、选择性激光烧结和3D喷印的工作原理、存在的优缺点以及国内外学者在该领域的研究进展.目前骨组织工程支架的制备大多应用了3D打印技术,以生物可降解的活性材料为原料制备而成.在我国该领域虽然发展迅速,利用3D打印技术进行人工骨合成、骨科术前模拟等已经越来越普遍,亦取得了令人满意的效果,但要研发出合适的生物材料以及设备精度的改进仍是亟待解决的问题.目前,仿生器官的功能化已成为3D打印技术领域的一大困难,其中多细胞共培养、血管化及支架的制备是实现功能化必须克服的问题,相信通过努力,该项技术将会为器官的再生与修复带来更多令人瞩目的成果.     

Organ printing: promises and challenges

Organ printing or biomedical application of rapid prototyping, also defined as additive layer-by-layer biomanufacturing, is an emerging transforming technology that has potential for surpassing traditional solid scaffold-based tissue engineering. Organ printing has certain advantages: it is an automated approach that offers a pathway for scalable reproducible mass production of tissue engineered products; it allows a precised simultaneous 3D positioning of several cell types; it enables creation tissue with a high level of cell density; it can solve the problem of vascularization in thick tissue constructs; finally, organ printing can be done in situ. The ultimate goal of organ-printing technology is to fabricate 3D vascularized functional living human organs suitable for clinical implantation. The main practical outcomes of organ-printing technology are industrial scalable robotic biofabrication of complex human tissues and organs, automated tissue-based in vitro assays for clinical diagnostics, drug discovery and drug toxicity, and complex in vitro models of human diseases. This article describes conceptual framework and recent developments in organ-printing technology, outlines main technological barriers and challenges, and presents potential future practical applications.     

3D打印技术在脊柱外科中的应用进展

总结国内外脊柱外科,特别是在复杂脊柱疾病中（尤其是严重脊柱畸形和脊柱肿瘤）使用3D打印技术的文献,重点关注提到的3D打印种类、具体应用方法、治疗效果以及成本效益分析。对在脊柱外科手术中使用3D打印技术的文献进行电子检索,国内文献使用中国知网数据库进行检索,国外文献使用PubMed以及Web of Science数据库进行检索。检索词为:脊柱外科、3D打印技术、增材制造、快速成型、脊柱畸形、脊柱肿瘤;英文词为:Spine、Scoliosis、Spinal Tumor、3D printing、Additive manufacturing、Rapid prototyping。并对纳入的文献进行分类总结,检索到文献116篇（中文72篇,英文44篇）,进行全文阅读分析后纳入文献35篇（中文15篇,英文20篇）。根据文献内容将3D打印应用分为手术导板、解剖模型以及个体化植入物。纳入文献提到的优点主要有减少手术时间、出血量、术中照射次数以及手术并发症发生率、改善治疗效果、提高患者满意度等。主要局限在于该技术目前缺乏统一标准、额外的打印费用、增加的学习成本、设计3D打印物耗费的时间以及植入物远期可靠性等。3D打印技术在脊柱疾病的治疗中确有价值,但在常见脊柱疾病中使用3D打印技术的意义和价值并不大,只有在较为复杂的病例中使用这项技术才能符合成本效益原则。     

Personalized development of human organs using 3D printing technology

3D printing is a technique of fabricating physical models from a 3D volumetric digital image. The image is sliced and printed using a specific material into thin layers, and successive layering of the material produces a 3D model. It has already been used for printing surgical models for preoperative planning and in constructing personalized prostheses for patients. The ultimate goal is to achieve the development of functional human organs and tissues, to overcome limitations of organ transplantation created by the lack of organ donors and life-long immunosuppression.We hypothesized a precision medicine approach to human organ fabrication using 3D printed technology, in which the digital volumetric data would be collected by imaging of a patient, i.e. CT or MRI images followed by mathematical modeling to create a digital 3D image. Then a suitable biocompatible material, with an optimal resolution for cells seeding and maintenance of cell viability during the printing process, would be printed with a compatible printer type and finally implanted into the patient.Life-saving operations with 3D printed implants were already performed in patients. However, several issues need to be addressed before translational application of 3D printing into clinical medicine. These are vascularization, innervation, and financial cost of 3D printing and safety of biomaterials used for the construct.     

3D打印技术在儿童骨科的应用研究进展

目的 总结3D打印技术在儿童骨科的研究进展,为3D打印技术与儿童骨科更好地融合发展提供理论依据。方法 以“3D打印”“小儿骨科”“解剖模型”“畸形矫形”“骨肿瘤”和“three-dimensional printing”“pediatric orthopaedic”“anatomical mode”“deformity orthopaedic”“orthopaedic”“bone tumour”为中英文关键词分别在中国知网、万方数据、PubMed、Web of Science 等数据库检索2010年1月-2019年9月关于3D打印技术在儿童骨科应用研究的文献,对其进行归纳分析。结果 共检索到相关文献1 197篇,其中中文文献540篇、英文文献657篇,剔除重复性研究、内容不符、无法获取全文,以及3D打印技术应用于成年患者和颅颌外科领域相关的文献,最终纳入文献34篇。3D打印技术可以制造个体化解剖模型,模拟手术操作、设计手术方案;制造导航模板指引手术;制造个体化支架;在骨组织工程方面亦取得一定的进展。结论 3D打印技术快速、精准、个性化的特点,促进了骨科手术个性化、微创化的发展。3D打印技术将通过外科教育、术前规划、个体化定制手术材料(如植入物、假体和手术导板等)以及组织工程的应用来改善手术效果。     

Advances in 3D cell culture technologies enabling tissue‐like structures to be created in vitro

Research in mammalian cell biology often relies on developing in vitro models to enable the growth of cells in the laboratory to investigate a specific biological mechanism or process under different test conditions. The quality of such models and how they represent the behavior of cells in real tissues plays a critical role in the value of the data produced and how it is used. It is particularly important to recognize how the structure of a cell influences its function and how co‐culture models can be used to more closely represent the structure of real tissue. In recent years, technologies have been developed to enhance the way in which researchers can grow cells and more readily create tissue‐like structures. Here we identify the limitations of culturing mammalian cells by conventional methods on two‐dimensional (2D) substrates and review the popular approaches currently available that enable the development of three‐dimensional (3D) tissue models in vitro. There are now many ways in which the growth environment for cultured cells can be altered to encourage 3D cell growth. Approaches to 3D culture can be broadly categorized into scaffold‐free or scaffold‐based culture systems, with scaffolds made from either natural or synthetic materials. There is no one particular solution that currently satisfies all requirements and researchers must select the appropriate method in line with their needs. Using such technology in conjunction with other modern resources in cell biology (e.g. human stem cells) will provide new opportunities to create robust human tissue mimetics for use in basic research and drug discovery. Application of such models will contribute to advancing basic research, increasing the predictive accuracy of compounds, and reducing animal usage in biomedical science.     

以电脑三维骨骼肌肉模型作生物力学分析在运动科学及医学上的意义与应用

将生理学、工程分析和计算机三维图像技术结合起来打开了创造"虚拟人"的大门。本文报道了一种具有广泛应用基础且功能齐全的人类肌肉骨骼系统的生理生物力学仿真技术。该仿真技术从结构水平、静态和动态模型的可视化结果上,并综合利用生物力学分析及图形化建模的专业知识来研究骨骼关节和软组织的力学性能,可与人体组织符合的模型包括假体植入物、内固定系统、功能康复锻炼装置,以及一个功能强大的计算平台联合在一起形成一个可在不同边界及加载条件下作静态、动态、动力学、应力及应变分析的应用软件系统及数据库—简称为VIMS(Virtua     

Application of soft tissue modelling to image-guided surgery

The deformation of soft tissue compromises the accuracy of image-guided surgery based on preoperative images, and restricts its applicability to surgery on or near bony structures. One way to overcome these limitations is to combine biomechanical models with sparse intraoperative data, in order to realistically warp the preoperative image to match the surgical situation. We detail the process of biomechanical modelling in the context of image-guided surgery. We focus in particular on the finite element method, which is shown to be a promising approach, and review the constitutive relationships which have been suggested for representing tissue during surgery. Appropriate intraoperative measurements are required to constrain the deformation, and we discuss the potential of the modalities which have been applied to this task. This technology is on the verge of transition into clinical practice, where it promises to increase the guidance accuracy and facilitate less invasive interventions. We describe here how soft tissue modelling techniques have been applied to image-guided surgery applications.     

构建3D打印牙齿模型及其形态仿真性研究

目的　应用3D打印技术构建出3D打印牙齿模型以替代离体牙,并通过形态仿真性研究来探讨3D打印牙齿模型在临床应用前景。 方法　选择合适的3D打印材料及设备并测试材料根管成型能力。用锥形束CT筛选出完整的单根管前牙、双根管前磨牙、双根管磨牙、三根管磨牙,再行显微CT扫描并数字化三维重建,获得3D打印牙齿模型。对模型二次扫描并重建,利用Geomagic Qualify 11与原牙齿三维模型进行三维比较,通过检测模型与原牙齿的差异来分析不同材料3D打印牙齿模型的精确度。 结果　成功构建出3D打印牙齿模型。在表面形态上,Wic300a模型组绝对偏差值为（0.008121±0.0480）mm,E-Dent模型组为（0.009554±0.0526）mm;髓腔形态上,Wic300a模型组绝对偏差值为（0.045181±0.1022）mm,E-Dent模型组为（0.056953±0.1995）mm。 结论　3D打印牙齿模型离体牙仿真度较高,3D打印牙齿模型可用于口内操作培训及术前模拟等。     

Tissue vascularization through 3D printing: Will technology bring us flow?

Background: Though in vivo models provide the most physiologically relevant environment for studying tissue function, in vitro studies provide researchers with explicit control over experimental conditions and the potential to develop high throughput testing methods. In recent years, advancements in developmental biology research and imaging techniques have significantly improved our understanding of the processes involved in vascular development. However, the task of recreating the complex, multi‐scale vasculature seen in in vivo systems remains elusive. Results: 3D bioprinting offers a potential method to generate controlled vascular networks with hierarchical structure approaching that of in vivo networks. Bioprinting is an interdisciplinary field that relies on advances in 3D printing technology along with advances in imaging and computational modeling, which allow researchers to monitor cellular function and to better understand cellular environment within the printed tissue. Conclusions: As bioprinting technologies improve with regards to resolution, printing speed, available materials, and automation, 3D printing could be used to generate highly controlled vascularized tissues in a high throughput manner for use in regenerative medicine and the development of in vitro tissue models for research in developmental biology and vascular diseases. Developmental Dynamics 244:629–640, 2015. © 2015 Wiley Periodicals, Inc.     

Software for browsing sectioned images of a dog body and generating a 3D model

The goals of this study were (1) to provide accessible and instructive browsing software for sectioned images and a portable document format (PDF) file that includes three‐dimensional (3D) models of an entire dog body and (2) to develop techniques for segmentation and 3D modeling that would enable an investigator to perform these tasks without the aid of a computer engineer. To achieve these goals, relatively important or large structures in the sectioned images were outlined to generate segmented images. The sectioned and segmented images were then packaged into browsing software. In this software, structures in the sectioned images are shown in detail and in real color. After 3D models were made from the segmented images, the 3D models were exported into a PDF file. In this format, the 3D models could be manipulated freely. The browsing software and PDF file are available for study by students, for lecture for teachers, and for training for clinicians. These files will be helpful for anatomical study by and clinical training of veterinary students and clinicians. Furthermore, these techniques will be useful for researchers who study two‐dimensional images and 3D models. Anat Rec, 299:81–87, 2016. © 2015 Wiley Periodicals, Inc.     

3D打印数字化导航模块辅助股骨颈中空拉力螺钉的精准置入

BACKGROUND: Computer-assisted orthopedic technique can help physicians develop more accurate preoperative planning and surgical simulation. 3D printing technology erects a bridge for the virtual design and implementation, and the design of the surgical program will be accurately put into practice.     

应用Masquelet技术治疗大段骨缺损减少自体骨用量的可能性

文题释义：Masquelet技术：又称诱导膜技术,是目前治疗大段骨缺损的有效方法之一。该技术由2个阶段组成,第一个阶段为培育诱导膜阶段,该阶段进行彻底清创后以骨水泥充填骨缺损,充分的软组织覆盖;第二个阶段为植入自体骨阶段,该阶段在完整保留诱导膜的情况下去除骨水泥,充填自体骨。 骨运输技术：又称Ilizarov 技术,指将骨切断成为2个骨段并保留软组织及血供,用牵张器固定,经一段时间后按一定速度和频率逐步施加牵拉力将骨段牵开,基于张力-应力法则,骨段被缓慢牵拉时会保持一定张力,可刺激组织生长新骨不断增殖,达到骨延长目的。 背景：Masquelet技术是目前治疗大段骨缺损的有效方法之一,该技术在手术治疗的第二阶段中需要使用较多的自体骨,而自体骨来源有限且存在供区并发症的风险,如何减少自体骨的使用量是一个亟待解决的问题。 目的：结合国内外诱导膜技术的发展现状,介绍在诱导膜技术中如何减少自体骨用量的一些有效方法,包括填充骨移植替代材料及一些特殊的手术方式。 方法：由第一作者应用计算机检索PubMed、知网、万方数据库中1996年1月至2019年9月出版的文献,英文检索词为“masquelet technique;induced membrane;bone transport technique;autologous bone;bone defect;bone graft;3D printing;tissue engineering”;中文检索词为“Masquelet技术;诱导膜;骨运输技术;自体骨;骨缺损;骨移植物;3D打印;组织工程”。 结果与结论：自诱导膜技术出现之后不断有学者对该术式进行改进与创新,但针对如何减少诱导膜第二阶段自体骨使用量的问题,目前还没有一种国际统一的观点。目前应用的改进方式各有其优缺点,临床医师还需根据客观条件进行选择。Jong-Keon Oh提出的将明胶海绵作为植骨中心、外周环形植骨的方法简单且实用。组织工程技术具有发展潜力,随着种子细胞与支架材料的深入研究,将逐步取代现有的治疗方案。根据现有研究可大致将未来诱导膜技术研究方向归纳为4种方向：膜技术的改进,手术方式的改进,应用联合材料,3D打印及组织工程技术的应用,这些方向需要进一步探索和发展。 ORCID: 0000-0003-4274-0421(王钊) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程