ObjectiveTo evaluate the effectiveness of high tibial osteotomy (HTO) assisted by three-dimensional (3-D) printing technology for correction of varus knee with osteoarthritis. MethodBetween January 2014 and June 2015, 16 patients (20 knees) with varus knee and osteoarthritis underwent HTO assisted by 3-D printing technology; a locking compression plate was used for internal fixation after HTO. There were 6 males and 10 females, aged 30-60 years (mean, 45.5 years). The disease duration was 1-10 years (mean, 6.2 years). The unilateral knee was involved in 12 cases and bilateral knees in 4 cases. According to Koshino's staging system, 3 knees were classified as stage I, 7 knees as stage Ⅱ, 8 knees as stage Ⅲ, and 2 knees as stage IV. Preoperative Hospital for Special Surgery (HSS) knee score was 63.8±2.2; the femorotibial angle was (184.8±2.9) °; and Insall-Salvati index was 1.03±0.13. ResultsAll the wounds healed primarily, and no complication of infection, osteofacial compartment syndrom, or deep vein thrombosis was observed. All patients were followed up 6-18 months (mean, 12.6 months). Personal paralysis was observed in 1 case (1 knee), and was cured after expectant treatment. Bone union time was 2.7-3.4 months (mean, 2.9 months). At 6 months after operation, the femorotibial angle was (173.8±2.0) °, showing significant difference when compared with preoperative one (t=11.70, P=0.00) ; Insall-Salvati index was 1.04±0.12, showing no significant difference when compared with preoperative one (t=-0.20, P=0.85) ; and HSS knee score was significantly increased to 88.9±3.1 (t=-25.44, P=0.00) . At last follow-up, the results were excellent in 13 knees, good in 6 knees, fair in 1 knee, and the excellent and good rate was 95%. Conclusions3-D printing cutting block can greatly improve the accuracy of HTO, avoid repeated X-ray and multiple osteotomy, shorten the operation time, and ensure better effectiveness for correction of varus knee with osteoarthritis.
Objective To evaluate the effectiveness of distal femoral osteotomy aided by three-dimensional (3D) printing cutting block for correction of vaglus knee with osteoarthritis. Methods Between January 2014 and January 2016, 12 patients (15 knees) with vaglus deformity and lateral osteoarhritis underwent medial closing wedge distal femoral osteotomy. There were 5 males and 7 females, aged 30-60 years (mean, 43.8 years). The mean disease duration was 6.6 years (range, 1–12 years). The unilateral knee was involved in 9 cases and bilateral knees in 3 cases. According to Koshino’s staging system, 1 knee was classified as stage I, 9 knees as stage II, and 5 knees as stage III. The X-ray films of bilateral lower extremities showed that the femorotibial angle (FTA) and anatomical lateral distal femoral angle (aLDFA) were (160.40±2.69)° and (64.20±2.11)° respectively. Mimics software was used to design and print the cutting block by 3D printing technique. During operation, the best location of distal femoral osteotomy was determined according to the cutting block. After osteotomy, internal fixation was performed using a steel plate and screws. Results All incisions healed primarily; no complication of infection or deep vein thrombosis was observed. All patients were followed up 6-18 month (mean, 12.2 months). At 6 months after operation, the hospital for special surgery (HSS) score for knee was significantly improved to 89.07±2.49 when compared with preoperative score (65.27±1.49,t=–28.31,P=0.00); the results were excellent in 10 knees, good in 4 knees, and fair in 1 knee with an excellent and good rate of 93.3%. The bony union time was 2.9-4.8 months (mean, 3.3 months). Bone delayed union occurred in 1 case (1 knee). The postoperative FTA and aLDFA were (174.00±1.41)° and (81.87±1.06)° respectively, showing significant differences when compared with preoperative ones (t=–18.26，P=0.00;t=–25.19,P=0.00). The percentage of medial tibial plateau in whole tibial plateau was 49.78%±0.59%, showing no significant difference when compared with intraoperative measurement (49.82%±0.77%,t=0.14,P=0.89). Conclusion 3D printing cutting block can greatly improve the accuracy of distal femoral osteotomy, and ensure better effectiveness for correction of vaglus knee with osteoarthritis.
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. Methods Between March 2013 and December 2015, 15 patients (18 knees) with extra-articular deformity and KOA underwent TKA. There were 6 males (6 knees) and 9 females (12 knees), aged 55-70 years (mean, 60.2 years). The mean disease duration was 10.8 years (range, 7-15 years). The unilateral knee was involved in 12 cases and bilateral knees in 3 cases. The clinical score was 57.44±1.06 and the functional score was 60.88±1.26 of Knee Society Score (KSS). The range of motion of the knee joint was (72.22±0.18)°. The deviation of mechanical axis of lower limb was (18.89±0.92)° preoperatively. There were 8 cases (10 knees) with extra-articular femoral deformity, 5 cases (5 knees) with extra-articular tibial deformity, and 2 cases (3 knees) with extra-articular femoral and tibial deformities. Bone models and the navigation templates were printed and the operation plans were designed using 3D printing technology. The right knee joint prostheses were chosen. Results The operation time was 65-100 minutes (mean, 75.6 minutes). The bleeding volume was 50-150 mL (mean, 90.2 mL). There was no poor incision healing, infection, or deep venous thrombosis after operation. All patients were followed up 12- 30 months (mean, 22 months). Prostheses were located in the right place, and no sign of loosening or subsidence was observed by X-ray examination. At last follow-up, the deviation of mechanical axis of lower limb was (2.00±0.29)°, showing significant difference when compared with preoperative one (t=13.120, P=0.007). The KSS clinical score was 87.50±0.88 and function score was 81.94±1.41, showing significant differences when compared with preoperative ones (t=27.553, P=0.000; t=35.551, P=0.000). The range of motion of knee was (101.94±1.42)°, showing significant difference when compared with preoperative one (t=31.633, P=0.000). Conclusion For KOA accompanied with extra-articular deformity, TKA using 3D printing technology has advantages such as individualized treatment, reducing the difficulty of operation, and achieving the satisfactory function.
Objective To discuss the effect of three-dimensional (3D) printing individualized model and guide plate in bone tumor surgery. Methods Between October 2015 and December 2016, 3D printing individualized model and guide plate for making preoperative surgical planning and intraoperative treatment were used in 5 patients of bone tumor. All the patients were male, with a median age of 32 years (range, 9-58 years). There were 1 case of cystic echinococcosis at left pelvis and pathological fracture of the proximal femur; 1 case of left iliac bone osteoblastoma associated with aneurysmal bone cyst; 1 case of fibrous dysplasia of the left femur (sheep horn deformity) with pathological fracture; 1 case of metastatic carcinoma of right calcaneus (tumor staging was T2N0M0); and 1 case of Ewing sarcoma of left femur (tumor staging was T2N0M0). The disease duration ranged from 1 month to 10 years (mean, 2.25 years). Results The operation was completed successfully. The operation time was 2.6-7.5 hours (mean, 4.9 hours). The intraoperative blood loss was 200-2 500 mL (mean, 1 380 mL). The intraoperative fluoroscopy times was 1-6 times (mean, 3.8 times). There was no infection after operation, and the blood supply and nerve function were good. All the patients were followed up 3-16 months (mean, 5.4 months). No loosening or breaking of the internal fixator occurred. According to Enneking scoring system, the limb function score was 15-26 (mean, 21); and the results were excellent in 2 cases, good in 2 cases, and fair in 1 case. Conclusion 3D printing technology can make the implementation of the better preoperative planning and evaluation in bone tumor surgery, and it provides a new reference for individualized treatment in patients with bone tumor.
Objective To investigate the application value of three-dimensional (3-D) printing technology in the operation of distal tibia fracture involving epiphyseal plate injury for teenagers. Methods The retrospective analysis was conducted on the clinical data of 16 cases of children patients with distal tibia fracture involving epiphyseal plate injury undergoing the operation by using of 3-D printing technology between January 2014 and December 2015. There were 12 males and 4 females with an age of 9-14 years (mean, 12.8 years). The causes of injury included traffic accident injury in 9 cases, heavy pound injury in 3 cases, and sport injury in 4 cases. The time from injury to operation was 3-92 hours (mean, 25.8 hours). According to Salter-Harris typing standard, the typing for epiphyseal injury was classified as type Ⅱ in 11 cases, type Ⅲ in 4 cases, and type Ⅳ in 1 case. The thin slice CT scan on the affected limb was performed before operation, and the Mimics14.0 medical software was applied for the design and the 1∶1 fracture model was printed by the 3-D printer; the stimulation of operative reduction was made in the fracture model, and bone plate, Kirschner wire, and hollow screw with the appropriate size were chosen, then the complete operative approach and method were designed and the internal fixator regimen was chosen, then the practical operation was performed based on the preoperative design regimen. Results The operation time was 40-68 minutes (mean, 59.1 minutes); the intraoperative blood loss was 5-102 mL (mean, 35 mL); the intraoperative fluoroscopy times was 2-6 times (mean, 2.8 times). All the patiens were followed up 12-24 months (mean, 15 months). The fracture of 15 cases reached anatomic reduction, and 1 cases had no anatomic reduction with the displaced end less than 1 mm. All the fractures reached bony union with the healing time of 2-4 months (mean, 2.6 months). There was no deep vein thrombosis, premature epiphyseal closure and oblique, or uneven ankle surface occurred, and there was no complication such as osteomyelitis, varus or valgus of ankle joint, joint stiffness, traumatic arthritis. Helfet scores of ankle function were measured at 12 months after operation, the results were excellent in 15 cases and good in 1 case. The angulation of introversion and extroversion for the affected limb was (6.56±2.48)°, and the growth length was (4.44±2.31) mm, and there was no significant difference (t=0.086, P=0.932; t=0.392, P=0.697) when compared with the uninjured side [(6.50±1.51)°, (4.69±1.08) mm]. Conclusion As the assistive technology, 3-D printing technology has a certain clinical application value in improving the effectiveness of distal tibia fracture involving epiphyseal plate injury.
ObjectiveTo explore the feasibility of the repair and reconstruction of large talar lesions with three-dimensional (3D) printed talar components by biomechanical test.MethodsSix cadaveric ankle specimens were used in this study and taken CT scan and reconstruction. Then, 3D printed talar component and osteotomy guide plate were designed and made. After the specimen was fixed on an Instron mechanical testing machine, a vertical pressure of 1 500 N was applied to the ankle when it was in different positions (neutral, 10° of dorsiflexion, and 14° of plantar flexion). The pressure-bearing area and pressure were measured and calculated. Then osteotomy on specimen was performed and 3D printed talar components were implanted. And the biomechanical test was performed again to compare the changes in pressure-bearing area and pressure.ResultsBefore the talar component implantation, the pressure-bearing area of the talus varied with the ankle position in the following order: 10° of dorsiflexion > neutral position > 14° of plantar flexion, showing significant differences between positions ( P<0.05). The pressure exerted on the talus varied in the following order: 10° of dorsiflexion < neutral position < 14° of plantar flexion, showing significant differences between positions (P<0.05). The pressure-bearing area and pressure were not significantly different between before and after talar component implantations in the same position (P>0.05). The pressure on the 3D printed talar component was not significantly different from the overall pressure on the talus (P>0.05).ConclusionApplication of the 3D printed talar component can achieve precise repair and reconstruction of the large talar lesion. The pressure on the repaired site don’t change after operation, indicating the clinical feasibility of this approach.
ObjectiveTo prepare dopamine modified and cartilage derived morphogenetic protein 1 (CDMP1) laden polycaprolactone-hydroxyapatite (PCL-HA) composite scaffolds by three-dimensional (3D) printing and evaluate the effect of 3D scaffolds on in vitro chondrogenic differentiation of human bone marrow mesenchymal stem cells (hBMSCs).MethodsA dimensional porous PCL-HA scaffold was fabricated by 3D printing. Dopamine was used to modify the surface of PCL-HA and then CDMP-1 was loaded into scaffolds. The surface microstructure was observed by scanning electron microscope (SEM) and porosity and water static contact angle were also detected. The cytological experiment in vitro were randomly divided into 3 groups: group A (PCL-HA scaffolds), group B (dopamine modified PCL-HA scaffolds), and group C (dopamine modified and CDMP-1 laden PCL-HA scaffolds). The hBMSCs were seeded into three scaffolds, in chondrogenic culture conditions, the cell adhesive rate, the cell proliferation (MTT assay), and cell activity (Live-Dead staining) were analyzed; and the gene expressions of collagen type Ⅱ and Aggrecan were detected by real-time fluorescent quantitative PCR.ResultsThe 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).ConclusionCo-culture of dopamine modified and CDMP1 laden PCL-HA scaffolds and hBMSCs in vitro can promote hBMSCs’ adhesion, proliferation, and chondrogenic differentiation.
ObjectiveTo manufacture a polycaprolactone (PCL)/type Ⅰ collagen (COL Ⅰ) tissue engineered meniscus scaffold (hereinafter referred to as PCL/COL Ⅰ meniscus scaffold) by three-dimensional (3D) printing with low temperature deposition technique and to study its physicochemical properties.MethodsFirst, the 15% PCL/4% COLⅠ composite solution and 15% PCL simple solution were prepared. Then, 15% PCL/4% COL Ⅰmeniscus scaffold and 15% PCL meniscal scaffold were prepared by using 3D printing with low temperature deposition techniques. The morphology and microstructure of the scaffolds were observed by gross observation and scanning electron microscope. The compression modulus and tensile modulus of the scaffolds were measured by biomechanical test. The components of the scaffolds were analyzed by Fourier transform infrared spectroscopy (FTIR). The contact angle of the scaffold surface was measured. The meniscus cells of rabbits were cultured with the two scaffold extracts and scaffolds, respectively. After cultured, the cell proliferations were detected by cell counting kit 8 (CCK-8), and the normal cultured cells were used as controls. Cell adhesion and growth of scaffold-cell complex were observed by scanning electron microscope.ResultsAccording to the gross and scanning electron microscope observations, two scaffolds had orientated 3D microstructures and pores, but the surface of the PCL/COLⅠ meniscus scaffold was rougher than the PCL meniscus scaffold. Biomechanical analysis showed that the tensile modulus and compression modulus of the PCL/COL Ⅰ meniscus scaffold were not significantly different from those of the PCL meniscus scaffold (P>0.05). FTIR analysis results showed that COL Ⅰ and PCL were successful mixed in PCL/ COL Ⅰ meniscus scaffolds. The contact angle of PCL/COLⅠ meniscus scaffold [(83.19±7.49)°] was significantly lower than that of PCL meniscus scaffold [(111.13±5.70)°] (t=6.638, P=0.000). The results of the CCK-8 assay indicated that with time, the number of cells cultured in two scaffold extracts showed an increasing trend, and there was no significant difference when compared with the control group (P>0.05). Scanning electron microscope observation showed that the cells attached on the PCL/ COL Ⅰ meniscus scaffold more than that on the PCL scaffold.ConclusionPCL/COLⅠmeniscus scaffolds are prepared by 3D printing with low temperature deposition technique, which has excellent physicochemical properties without cytotoxicity. PCL/COLⅠmeniscus scaffold is expected to be used as the material for meniscus tissue engineering.
With the development of three-dimensional (3D) printing technology, more and more researches have focused on its application in the region of intervertebral fusion materials; the prospects are worth looking forward to. This article reviews the researches about 3D printing technology in spinal implants, and summarizes the materials and printing technology applied in the field of spinal interbody fusion, and the shortcomings in the current research and application. With the rapid development of 3D printing technology and new materials, more and more 3D printing spinal interbodies will be developed and used clinically.
ObjectiveTo explore the gait trajectory characteristics of patients after total knee arthroplasty (TKA) assisted by three-dimensional (3D) printing navigation template.MethodsTwenty 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).ResultsThe 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).ConclusionAssisted 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.