3D打印金属内植物在骨科的应用特点

Application of three-dimensional printing metal implants in orthopedics

背景:对于严重创伤、肿瘤切除术后、关节翻修术造成的复杂骨缺损,由于缺损较大且不规则、病理状态下骨再生能力受限,使用骨科常规金属内植物难以达到满意的效果。目的:介绍3D打印金属内植物在骨科的临床应用,并讨论在基础研究中如何进一步优化3D打印金属内植物体系,加强骨缺损处骨再生及与宿主骨的整合效果。方法:作者以"3D printing,Bone defect,metal implant,prosthesis,3D打印,骨缺损,金属内植物,假体"为关键词,检索2005至2018年期间Pub Med、Web of Science、Springerlink、Medline、万方、CNKI数据库中相关文献。初检文章401篇,筛选后对67篇文章进行分析。结果与结论:(1)3D打印技术已广泛应用于医学、汽车制造、航空航天等领域;(2)3D打印金属关节、髋臼、椎体、骨盆等内植物已在临床得到应用,术后随访表明应用3D打印金属内植物的患者获得早期稳定性,内植物与宿主骨结合牢固,假体松动等并发症少见,获得较满意的效果;(3)在基础研究中对3D打印金属内植物进一步进行优化,应用优化3D打印支架孔隙结构和材料选择,羟基磷灰石、β-磷酸三钙、锶盐等进行生物涂层,纳入外源性干细胞和生长因子局部作用等方式,可以促进健康状态或者病理状态下的骨缺损愈合;(4)3D打印金属内植物个体化的设计、良好的力学性能和诱导骨长入能力显著促进假体-宿主骨的整合效果,为未来骨科发展提供了新方向。

BACKGROUND:For the complicated bone defects caused by severe trauma,tumor resection and arthroplasty,conventional metal implants cannot achieve satisfactory results because of the large and irregular defect and limited ability of bone regeneration in pathological condition.OBJECTIVE:To introduce the clinical application of three-dimensional(3D)-printed metal implants in orthopedics and to discuss how to further optimize the 3D-printed implant system in basic research,strengthen the bone regeneration at the defect region and the integrative effect in the host bone.METHODS:A computer-based retrieval of PubMed,Web of Science,Springerlink,Medline,WanFang and CNKI databases was performed for relevant articles published from 2005 to 2018.The keywords were“3D printing,bone defect,metal implant,prosthesis”in English and Chinese,respectively.Initially,401 articles were retrieved,and finally 67 eligible articles were included for result analysis.RESULTS AND CONCLUSION:(1)3D printing technology has been widely used in medicine,automobile manufacturing,aerospace and other fields.(2)3D printing metal joints,acetabulum,vertebral body,pelvis and other implants have been applied in clinical practice.The follow-up results show that patients with 3D printing internal plants have early stability,the close implant-bone connection,and prosthesis loosening is rare,and the clinical results are satisfactory.(3)The further optimization of 3D printing metal plants in basic research,the application of optimizing the pore structure and material selection of 3D printing stents,hydroxyapatite,beta tricalcium phosphate,strontium salt and other biological coatings,including the local action of exogenous stem cells and growth factors,can promote the state of health or the pathological state.(4)The individualized design of 3D printed metal implant,good mechanical properties and the ability to induce bone growth significantly promote the integration effect of the prosthesis-host bone and provide a new direction for orthopedics.