个性化3D打印在去骨瓣减压术后脑保护中的应用价值

Role of personalized 3D printing in brain protection after decompressive craniectomy

目的探讨个性化3D打印脑保护帽在去骨瓣减压术后脑保护中的应用价值。方法选择2021年1至10月厦门大学附属第一医院神经外科及徐州市中心医院神经外科去骨瓣减压术后的患者(45例),其中男26例,女19例,年龄5~73(50±13)岁。基于术后颅脑CT影像数据个性化三维重建设计脑保护帽进行3D打印,佩戴在患者头部,保护脑组织免受外力所引起的二次损伤,并与同期未佩戴保护帽的患者(53例)进行随访结果比较。结果两组患者年龄、颅骨缺损位置和随访时间比较,差异均无统计学意义(均P>0.05)。佩戴脑保护帽的45例患者共设计并打印47例脑保护帽(2例为双侧缺损),影像后处理时间为(21.2±6.0)min,3D打印时间为(62.4±8.3)min,低度符合6例、中度符合9例、高度符合32例,6例低度符合的脑保护帽全部重新设计打印后均达到高度符合标准,9例中度符合的脑保护帽2例进行重新设计打印后达到高度符合标准,其余7例通过打磨包装后达到高度符合标准。本研究45例脑保护帽患者术后3个月随访均未出现二次意外脑损伤,同期53例未佩戴脑保护帽患者,术后3个月随访期间4例出现二次意外脑受压,损伤发生率7.5%。两组患者脑部二次意外发生率比较,差异有统计学意义(P<0.001)。结论基于颅脑CT数据和3D打印技术所设计的脑保护帽可以保护颅骨缺损患者,避免脑组织受压,具有一定的临床价值。

Objective To explore the application value of personalized three-dimensional(3D)printed protective cap in brain protection after decompressive craniectomy(DC).Methods Fourty-five patients who underwent DC from January 2021 to October 2021 were selected,including 26 males and 19 females,aged 5-73(50±13)years old.The brain CT data were imported into 3D Slicer software to rebuild the protective cap through 3D printing.The cap was worn on the head of the patient,thereby preventing secondary braindamage.The follow-up results were compared with 53 patients without protective capduring the same period.Results There were no statistically significant differences in age,skull defect location and follow-up time between the two groups(all P>0.05).Among 45 patients,47 brain protective caps(2 cases with bilateral skull defects)were successfully designed.The time for image post-processingand 3D printing was(21.2±6.0)min and(62.4±8.3)min,respectively.There were 6 cases of low compliance,9 cases of moderate compliance,32 cases of high compliance,respectively.Six cases with low conformity were redesigned and printed,2 of 9 cases with moderate conformity were redesigned and printed,and the remaining 7 cases reached high compliance after grinding and packaging.In the current study,45 patients with brain protective caps were followed up for 3 months,and no secondary brain injury occurred.However,among 53 patients without brain protective caps during the same period,4 patients had secondary accidental brain compression.The incidence of injury was 7.5%,and the difference was statistically significant(P<0.001).Conclusion Brain protective cap designed based on cranial CT and 3D printing can be used in patients with skull defects to protect the brain tissue from secondary crush damage and has certain clinical value.