3D打印技术在多学科协作脊柱肿瘤精准化、个性化手术治疗的应用

Application of 3D printing technology in multi-disciplinary treatment inspinal tumorprecise and individualized surgery

目的探讨3D打印技术在多学科协作诊疗(multi-disciplinary treatment,MDT)模式中脊柱肿瘤精准化、个性化手术的应用。方法回顾分析2016年6月至2018年12月,贵州医科大学附属医院多学科协作共同诊治的36例脊柱肿瘤患者,根据是否采用3D打印技术分为两组,观察组及对照组各18例。观察组术前应用3D打印技术,制作1∶1肿瘤区域脊柱实体模型及个性化椎弓根导板。术前根据3D打印模型设计手术方式,模拟手术及体外置钉,术中完成精准化肿瘤切除及准确置钉。比较两组的手术时间、出血量、透视次数、置钉准确率,术前术后采用VAS评分评定疗效。结果多学科协作完成的36例脊柱肿瘤手术,观察组18例术前应用3D打印技术,术中做到精准、完整的切除肿瘤、准确置钉,术中出血量、透视次数及手术时间均显著低于对照组,术后症状均获得明显好转,术后6、12个月随访VAS评分较术前有明显改善。结论3D打印技术应用于多学科协作下完成复杂的脊柱肿瘤手术,使术中精准、完整切除肿瘤,有效缩短手术时间,减少出血量,提高肿瘤切除的安全性和置钉准确率。

Objective To explore the application of 3 D printing technology in multi-disciplinary treatment(MDT)medical model in spinal tumor precision and individualized surgery.Methods 36 caseswith spinal tumors who received MDT in the AffiliatedHospital of Guizhou Medical University were retrospectively analyzed from June2016 to December 2018.They were divided into testgroup(n=18)and control group(n=18)according to using3 D Printing guide pedicle screw placement or not.In the test group,a full-scale model of tumor regional spine and an individualized pedicle guide plate were manufactured by 3 D printing technique modeling before operation.The surgical method was designed by 3 D printing model,the operation was simulated and screw placement.During the operation,the precise tumor resection and accurate screw placement were finished.The operation time,bleeding amount,fluoroscopy times and the accuracy rate of the screw placement were comparedin two groups.The curative effect was evaluated by VAS score during perioperative period.Results 18 cases in the test group were treated with 3 D printing technique before operation.The accuracy,complete resection,accurate screw placement,intraoperative bleeding,fluoroscopy times and operation time in the test group were significantly lower than those in the control group.The symptoms of all patients were improved obviously after operation,and the VAS scores of follow-up at 6 months and 12 months after operation were obviously improved compared with those before operation.Conclusions 3 D printing technique combined with MDT can be used to assist in the treatment of complex spinal tumor operation,enhance the safety and accuracy of tumor resection,complete the resection of tumor in a shorter time,reduce the amount of intraoperative bleeding,improve the accuracy of pedicle screw placement.