脑出血穿刺定位导板3D打印快速个体化定制模式的应用初探

Preliminary study on rapid customization mode of 3D printing positioning guide for individualized intracerebral hemorrhage puncture

目的探讨医工结合个体化快速3D打印脑内血肿穿刺定位导板定制流程的可行性、引导锥颅穿刺血肿置管引流术治疗高血压性脑出血的安全性。方法选择符合锥颅穿刺血肿引流术的高血压性脑出血患者,分别采用常规CT下金属标志物定位(对照组18例)或3D打印血肿穿刺导板定位(观察组21例),比较两种定位方法的安全性和可行性;3D打印血肿穿刺导板通过医院组建的医学影像数据传输、三维建模和3D打印一体化系统来完成个体化产品定制并应用于临床。结果两组脑出血患者均完成锥颅血肿穿刺置管引流手术,无手术死亡。术中穿刺精准度评价为优者观察组19例,对照组10例;术后血肿清除率评价为有效观察组18例,对照组9例;术后恢复情况观察组优于对照组;通过医学云影像传输、三维建模和3D打印等一体化服务系统,平均耗费时间江油市人民医院观察组为(5.78±4.84)h,对照组为(4.64±1.43)h,四川省人民医院分别为(5.08±0.67)h和(4.14±1.35)h;3D打印产品完成时间江油市人民医院(132.67±7.25)min,四川省人民医院(131.92±6.69)min;组间比较无显著统计学差异。结论利用医学云影像传输融合3D打印服务一体化系统,可快速个体化定制3D打印脑血肿穿刺定位导板,能简化定制流程和满足临床急诊手术服务需求,提高血肿穿刺精准度和血肿清除率,此定制模式也有利于医学3D打印产品服务于临床并推广。

Objective To explore the feasibility of the process for rapid customization of 3D printed hematoma puncture positioning guide plate with the combination of medicine and industry,and the safety of guided hematoma catheterization and drainage in the treatment of hypertensive intracerebral hemorrhage.Methods Selected patients with cerebral hemorrhage suitable for puncture hematoma drainage,and used conventional CT metal marker positioning(18 cases in the control group)and 3D printing hematoma puncture guide positioning plate(21 cases in the observation group)respectively to compare the safety and feasibility of the two positioning methods.The guide was customized and applied to the clinic through an integrated system of medical image data transmission,3D modeling and 3D printing.Results Both groups of patients with intracerebral hemorrhage completed the puncture and drainage of conical skull hematoma,and there was no operative death.The intraoperative puncture accuracy was evaluated as excellent in 19 cases in the observation group and 10 cases in the control group.The clearance rate of postoperative hematoma was evaluated as effective in 18 cases in the observation group and 9 cases in the control group.The postoperative recovery of the observation group was better than that of the control group.Through the integrated service system of medical cloud image transmission,3D modeling and 3D printing,the average time-consuming in the observation group of Jiangyou People’s Hospital was(5.78±4.84)h,the control group was(4.64±1.43)h,and the Sichuan People’s Hospital was(5.08±0.67)h and(4.14±1.35)h respectively.The completion time of 3D printing products was(132.67±7.25)min in Jiangyou People’s Hospital and(131.92±6.69)min in Sichuan People’s Hospital.There was no significant difference between the two groups.Conclusions Using medical cloud image transmission,3D printing and service integration system,3D printing cerebral hematoma puncture guide plate can be quickly and personalized customized,which can simplify the customization process and meet the needs of clinical emergency surgery services,and improve the accuracy of hematoma puncture and hematoma removal rate.This 3D printing service customization model is more conducive to serving the clinic and promotion.