ObjectiveTo explore the feasibility of lumbar puncture models based on 3D printing technology for training junior orthopaedic surgeons to find the optimal pedicle screw insertion points.MethodsMimics software was used to design 3D models of lumbar spine with the optimal channels and alternative channels. Then, the printed lumbar spine models, plasticine, and cloth were used to build lumbar puncture models. From January 2018 to June 2019, 43 orthopedic trainees performed simulated operations to search for the insertion points of pedicle screws base on the models. The operations were performed once a day for 10 consecutive days, and the differences in operation scores and operation durations of the trainees among the 10 days were compared.ResultsAll the trainees completed the surgical training operations successfully, and there were significant differences in the operation scores (13.05±2.45, 14.02±3.96, 17.58±3.46, 21.02±2.04, 23.40±4.08, 25.14±3.72, 27.26±6.09, 33.37±4.23, 35.00±4.15, 38.49±1.70; F=340.604, P<0.001) and operation durations [(22.51±4.28), (19.93±4.28), (18.05±2.89), (17.05±1.76), (16.98±1.97), (15.47±1.74), (13.51±1.42), (12.60±2.17), (12.44±1.71), (11.91±1.87) minutes; F=102.359, P<0.001] among the 10 days.ConclusionThe 3D models of lumbar puncture are feasible and repeatable, which can contribute to surgical training.
ObjectiveTo investigate the effectiveness of three-dimensional (3D) navigation template in the adult cubitus varus osteotomy.MethodsBetween April 2013 and September 2015, 17 patients with cubitus varus were admitted. There were 6 males and 11 females, aged from 19 to 38 years, with an average age of 26.9 years. There were 10 cases of left elbow joints and 7 cases of right elbow joints. The disease duration was 9-30 years (mean, 18 years). Based on the preoperative X-ray film, the humerus-elbow-wrist (HEW) angle was (−13.2 ±3.3)°, the anteversion angle was (−10.5±2.3)°. The preoperative range of motion (ROM) of flexion was (127.3±7.3)° and ROM of extension was (−10.0±2.5)°. Based on the CT 3D reconstruction, the osteotomy navigation template was designed and printed by 3D printing technique. The cubitus varus osteotomy was assisted by 3D navigation template. The postoperative HEW angle, anteversion angle, and ROMs of the elbow joints of both sides were measured. The elbow function was evaluated based on the Oppenheim elbow function score at 1 year after operation.ResultsAll cubitus varus osteotomies succeeded with the assist of 3D navigation template. All incisions healed by first intention. All patients were followed up 12-15 months (mean, 13 months). X-ray films showed that all osteotomies healed after 9-12 weeks (mean, 11 weeks). At 1 year after operation, the HEW angle was (9.7±1.9)°, the anteversion angle was (20.7±4.3)°, the ROM was (2.6±3.5)° in extension and (139.2±4.8)° in flexion of affected side. The HEW angle, anteversion angle, and ROMs significantly increased compared with preoperative values (P<0.05). And there was no significant difference between affected and normal elbow joints (P>0.05). The elbow functions were excellent in 13 cases and good in 4 cases based on the Oppenheim elbow function score at 1 year after operation. There was no complication such as the nerve injury or osteomyositis of elbow joint during follow-up. ConclusionThe 3D navigation template can provide a personalized and precise osteotomy treatment for adult cubitus varus deformity and obtain a satisfactory effectiveness.
ObjectiveTo investigate the short-term effectiveness of total knee arthroplasty (TKA) assisted by three-dimensional (3D) printing osteotomy navigation template.MethodsA retrospective study was performed on 60 patients with osteoarthritis bewteen January 2016 and June 2017. Thirty cases underwent TKA assisted by 3D printing osteotomy navigation template (3D printing group) and 30 cases underwent the conventional TKA (conventional TKA group). There was no significant difference in gender, age, body mass index, surgical side, and disease duration between 2 groups (P>0.05). The operation time, the pre- and post-operative hemoglobin values, the amount of drainage, the Hospital for Special Surgery (HSS) score and Knee Society Score (KSS) of knee joint before operation and at 3 months after operation were observed. And 6 freedom degrees of knee (the varus and valgus angle, the internal and external rotation angle, the antero-posterior displacement, the proximal-distal displacement, the flexion and extension angle, and the internal and external displacement) before operation and at 3 months after operation were recorded by Opti-Knee (the knee 3D motion analysis system). The values of 2 groups were compared with 30 healthy adults (<60 years).ResultsThe operation time was shorter in 3D printing group than that in conventional TKA group (t=5.833, P=0.000). The hemoglobin values at 1 and 3 days after operation were higher in 3D printing group than those in conventional TKA group (P<0.05). The amount of drainage was less in 3D printing group than that in conventional TKA group (t=5.468, P=0.000). All patients were followed up 6-9 months (mean, 7.3 months). There was no significant difference in pre- and post-operative HSS score and KSS clinical score between 2 groups (P>0.05). There was no significant difference in preoperative KSS function score between 2 groups (P>0.05), but the KSS function score of 3D printing group at 3 months after operation was higher than that of conventional TKA group (P<0.05). Before operation, the varus and valgus angle, the internal and external rotation angle, the antero-posterior displacement, the proximal-distal displacement of 3D printing group and conventional TKA group were larger than that of the healthy adults (P<0.05); there was no significant difference in the flexion and extension angle and the internal and external displacement between 2 groups and healthy adults (P>0.05). At 3 months after operation, compared with healthy adults, the varus and valgus angle of conventional TKA group was increased, the flexion and extension angle of conventional TKA group was decreased (P<0.05); the proximal-distal displacement and the internal and external displacement of 2 groups were decreased (P<0.05); there was no significant difference in other freedom degrees between groups (P>0.05). No sign of prosthesis loosening was observed by X-ray examination.ConclusionCompared with the traditional TKA, TKA assisted by the 3D printing osteotomy navigation template had such advantages as shorter operation time, less postoperative blood loss, and well postoperative recovery.
ObjectiveTo summarize the research progress of tissue engineering technology to promote bone tissue revascularization in osteonecrosis of the femoral head (ONFH).MethodsThe relevant domestic and foreign literature in recent years was extensively reviewed. The mechanism of femoral head vascularization and the application progress of tissue engineering technology in the promotion of ONFH bone tissue revascularization were summarized.ResultsRebuilding or improving the blood supply of the femoral head is the key to the treatment of ONFH. Tissue engineering is a hot spot in current research. It mainly focuses on the three elements of seed cells, scaffold materials, and angiogenic growth factors, combined with three-dimensional printing technology and drug delivery systems to promote the revascularization of the femoral bone tissue.ConclusionThe strategy of revascularization of the femoral head can improve the local blood supply and delay or even reverse the progression of ONFH disease.
ObjectiveTo investigate the short-term effectiveness of three-dimensional (3D) printing personalized prosthesis in the treatment of giant cell tumor of bone around knee joint.MethodsA clinical data of 9 patients with giant cell tumor of bone around knee joints and met the inclusive criteria between May 2014 and August 2017 was retrospectively analysed. There were 4 males and 5 females, with an average age of 35.8 years (range, 24-50 years). The lesion located at the distal femur in 4 cases and at the proximal tibia in 5 cases. The disease duration was 5-25 months (mean, 12.9 months). According to Campanacci grading, there were 2 patients of grade Ⅰ and 7 of grade Ⅱ. The 3D printing personalized prosthesis was designed based on the CT scanning and 3D reconstruction prepared before operation. All patients were treated with the tumor resection and 3D printing personalized prosthesis reconstruction. The radiological examination was taken to observe the tumor recurrence and the Musculoskeletal Tumor Society 1993 (MSTS93) score was used to evaluate the knee function.ResultsAll operations were successful and all incisions healed by first intention without early complications. All patients were followed up 24-40 months (mean, 31.2 months). At last follow-up, no complication such as pain, pathological fracture, prosthesis loosening, or tumor recurrence occurred. The MSTS93 score was 20-29 (mean, 24.7). The knee function was rated as excellent in 6 cases and good in 3 cases, with the excellent and good rate of 100%. ConclusionFor giant cell tumor of bone around knee joint, 3D printing personalized prosthesis has the advantages of bio-fusion with host bone, mechanical stability, good joint function, and ideal short-term effectiveness. But the middle- and long-term effectiveness still need to be further observed.
Objective To assess the application value of 3-dimensional(3D) printing technology in surgical treatment for congenital tracheal stenosis. Methods We retrospectively analyzed the clinical data of preoperative diagnosis, intra-operative decision-making and postoperative follow-up of four children with congenital tracheal stenosis under the guidance of 3D printing in our hospital between February 2013 and May 2014. There were 3 males and 1 female aged 23.0±7.1 months. Among them, two children were with pulmonary artery sling, one with ventricular septal defect, and the other one with tetralogy of Fallot. The airway stenosis was diagnosed preoperatively by chest CT scan and 3D printing tracheal models, and was confirmed by the help of bronchoscopy under anesthesia. During operation the associated cardiac malformation was corrected firstly under extracorporeal circulation followed by tracheal malformation remedy. The design and implementation of tracheal operation plans were guided by the shape and data from 3D printing trachea models. There were two patients with long segment of tracheal stenosis who received slide anastomosis. And the other two patients were characterized with tracheal bronchus, one of which combined ostial stenosis of right bronchial performed extensive slide anastomosis, and the other one performed end to end anastomosis. Results All the children’s preoperative 3D printing trachea models were in accord with bronchoscopy and intra-operative exploration results. Intra-operative bronchoscopy confirmed that all tracheal stenosis cured completely. All anastomotic stomas were of integrity, and all the luminals were fluent. There was no operative death or no serious complication. During 1-2 years follow-up, all patients breathed smoothly and their airways were of patency by postoperative 3D printing trachea model. Conclusion 3D printing can provide a good help to congenital tracheal stenosis in preoperative diagnosis, the design of operation plan, intra-operative decision-making and manipulation, which can improve the operation successful rate of tracheal stenosis.
Objective To review the application progress of digital technology in auricle reconstruction. Methods The recently published literature concerning the application of digital technology in auricle reconstruction was extensively consulted, the main technology and its specific application areas were reviewed. Results Application of digital technology represented by three-dimensional (3D) data acquisition, 3D reconstruction, and 3D printing is an important developing trend of auricle reconstruction. It can precisely guide auricle reconstruction through fabricating digital ear model, auricular guide plate, and costal cartilage imaging. Conclusion Digital technology can improve effectiveness and decrease surgical trauma in auricle reconstruction. 3D bioprinting of ear cartilage future has bright prospect and needs to be further researched.
ObjectiveTo analyze the clinical outcomes of 3D-printing assisting minimally invasive fixation of calcaneal fractures. MethodsThe study included 12 patients who were diagnosed with calcaneal fractures between October 2014 and May 2015. Using a real-size 3D-printed calcaneus model, the calcaneal locking plate could be preshaped before the operation and used with a minimally invasive approach to achieve rigid plate fixation just as with the lateral approach. Complications and surgery time were recorded and functional results were evaluated using the American Orthopaedic Foot Society ankle-metapedes score (AOFAS). The reduction of fracture was evaluated using the Bohler angle and Gissane angle. ResultsThere was no relevant postoperative complications. All fractures got bone union. The mean postoperative Bohler angle was (29.4±6.1) ° and the mean postoperative Gissane angle was (121.4±12.6) °. The difference in Bohler angle and calcaneal Gissane angle before and after the surgery was significant (P ＜ 0.01) . The mean postoperative AOFAS score was 75.2±5.4, and the fine/excellent rate was 83.3%. ConclusionWe believe this novel technique can be useful for the operative treatment of displaced intra-articular calcaneal fractures.
ObjectiveTo compare the postoperative tibial malrotation between traditional minimally invasive plate osteosynthesis (MIPO) and three-dimensional printing-assisted MIPO (3D-MIPO) for different types of tibial fractures, and explore the change of these differences.MethodsA prospective randomized controlled trial was conducted. The 120 patients with unilateral tibial fracture who met the selection criteria between January 2016 and October 2018 (40 patients in each of AO types A, B, and C) into the trial group (20 patients, 3D-MIPO) and the control group (20 patients, traditional MIPO) at ratio of 1∶1. There was no significant difference between the two groups (P>0.05) in gender, age, fracture site, and other general information. The bilateral tibial rotation angles were measured on the CT images within 1 week after operation, and the difference of tibial rotation angle between affected and unaffected sides was calculated. The tibial malrotation was defined when the difference exceeded 10°. The degree of tibial rotation and the incidence of malrotation between the two groups in different types of tibial fractures were compared. ResultsPostoperative infection occurred in 1 case, and improved after the dressing change and anti-inflammatory treatment. No complications such as loosening and displacement of internal fixation occurred. There was no significant difference in the difference of bilateral tibial rotation angles between the two groups in type A fractures after operation (t=0.559, P=0.580); while in types B and C fractures, the differences of bilateral tibial rotation angles in control group were significantly higher than those in trial group (P<0.05). There was no significant difference in distribution of internal or external rotation between the two groups in types A, B, and C fractures (P>0.05). No malrotation occurred in type A fractures, and there was no significant difference in the incidence of malrotation between the two groups in type B fractures (P=1.000). The incidence of malrotation in control group was significantly higher than that in trial group in type C fractures (P=0.044).Conclusion3D-MIPO has the same anti-malrotation effect as traditional MIPO for type A tibial fracture, but for types B and C tibial fractures, the anti-malrotation effect of 3D-MIPO is significantly better than that of traditional MIPO. The more complex the fracture type is, the more significant this advantage is.