3D打印钛合金胸肋骨植入物在胸壁重建中的临床应用

目的使用3D打印技术制造钛合金胸肋骨,并应用于大范围胸壁缺损的重建修复,以期满足个性化、解剖学的胸壁重建需求并观察其临床疗效。方法共纳入13例患者,男9例、女4例,年龄46(24~78)岁。所有患者均使用3D打印钛合金胸肋骨植入物对胸壁缺损进行重建,随访观察1年。收集患者的人口学特征,围手术期相关临床数据,并对获得数据进行统计学分析。结果6例肋骨肿瘤、6例胸骨肿瘤及1例胸骨化脓性骨髓炎患者最终纳入本研究。所有患者术后均能维持胸壁完整性,未发现反常呼吸现象,达到了个性化及解剖学的修复目的。胸壁缺损面积为(221.0±206.0)cm2。13例患者均顺利出院,围手术期内无死亡,2例发生肺炎。1年随访期内,未发生植入物断裂、移位、排斥、过敏等现象;1例患者化疗后切口溃疡,3例患者术后1年内肿瘤复发,其中2例患者发生死亡,12例肿瘤患者1年复发率25.0%,死亡率16.7%。结论3D打印钛合金胸肋骨植入物是一种安全和有效的胸壁缺损重建修复材料,可以满足个性化、解剖学的胸壁重建修复需求,且临床效果良好。

Clinical application of 3D printed titanium chest and rib implants in chest wall reconstruction

Objective In this study,three-dimensional printed(3DP)titanium implants were used for skeletal reconstructions after wide excision of chest wall.3DP titanium implants were expected to provide a valid option with perfect anatomic fitting and personalized design in chest wall reconstruction.Methods There were 13 patientsmean age of 46(24-78)years with 9 males and 4 females]who underwent adequate radical wide excision for tumors and chest wall reconstruction using 3DP titanium implants.Surgical data including patient demographic characteristics,perioperative clinical data and data from 1-year follow-up were collected and analyzed.Results Six patients of rib tumors,six patients of sternal tumors and one patient of sternal pyogenic osteomyelitis were finally selected for the study.The chest wall defect area was 221.0±206.0 cm2.All patients were able to maintain the integrity of the chest wall after surgery,and no abnormal breathing was found,achieving personalized and anatomical repair.Thirteen patients were successfully discharged from the hospital.Two patients developed pneumonia in the perioperative period.During the follow-up period in the first year after surgery,no implant related adverse reaction was observed,including implant rupture,implant shift,rejection reaction and allergies.One patient had wound ulcer after chemotherapy.Three patients had tumor recurrence,with the recurrence rate of 25.0%.Two patients died of tumor recurrence,with a mortality rate of 16.7%.Conclusion 3DP titanium implant is a safe and effective material for chest wall reconstruction.