自主3D打印技术在神经外科的应用价值探索

Application value of autonomous 3D printing technology in neurosurgery

目的探索自主设计制作3D打印器材的经验与效果,以供同行借鉴。方法选择2021年2月至11月在江汉大学附属湖北省第三人民医院利用自主3D打印技术辅助颅脑手术的患者6例(男4例,女2例;年龄34~73岁),通过3D-Slicer软件进行影像重建及模板制作,利用Ultimaker Cura软件设计打印流程并切片,选用热熔堆积固化成型打印机与PLA(聚乳酸打印)材料,最后利用打印的模板及模型引导手术,并评价其效果。结果共利用该技术辅助手术6例,其中2例脑出血及2例肿瘤设计的定位定向导板效果满意;1例颈内动脉床突上段大动脉瘤,模型的血管与其下方的支撑结构相融合,指导动脉瘤夹闭术效果差,但是制作三维模型的过程中获取的三维立体影像可辅助指导手术;1例眼动脉段动脉瘤,模型与三维影像一致,指导动脉瘤栓塞术效果满意。结论自主3D打印技术能满足手术的需求,用于引导穿刺、术前手术模拟与手术规划;对于复杂且关系紧密的结构,自主3D打印技术获取的三维建模影像与打印模型,二者相辅相成,可共同引导手术的进行。

Objective To explore the experiences and effect of self-designed and produced 3D printing equipment by physicians and to provide references for others.Methods Six patients undergoing cerebral surgery assisted by the autonomous 3D printing technology in The Third People's Hospital of Hubei Province,Jianghan University from February to November 2021 were selected,including 4 males and 2 females,and they were 34-73 years old.In this study,the 3D-Slicer software was used for image reconstruction and template production,the Ultimaker Cura software was used to design the printing process and slice,hot melt stacking curing printer and PLA printing materials were used,and finally the printed templates and models were used to guide the operation.The effect was evaluated.Results A total of 6 cases were assisted by this technique.The results of localization and orientation were satisfactory in 2 cases of cerebral hemorrhage and 2 cases of tumor.The clipping effect guided by the printed model for one case of internal carotid artery aneurysm was poor,because the model artery connected with the supporting structure below it,but the three-dimensional image obtained in the process of making the model could guide the aneurysm clipping.In the other case of eye artery aneurysm,the model was consistent with the 3D image,and the effect of aneurysm embolization was satisfactory.Conclusions Autonomous 3D printing technology can meet the needs of surgery,and can be used for guiding puncture,preoperative surgical simulation,and surgical planning.For complex and closely related structures,3D modeling images obtained by autonomous 3D printing technology can guide the operation together with the printed model.