西南地区首例!骨盆也能“量身定制” 省医院为患者装上3D打印半骨盆

来源:成都商报    关键词:3D打印,3D打印技术,3D打印运用,    发布时间:2019-07-16

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7月11日,在四川省人民医院,64岁的苏女士的手术已完成了9天,3D打印的半个骨盆正和医生预期的一样,慢慢地与苏女士自身的骨头稳固地“结合”在一起,再过一段时间,她就能重新站起来,开始功能锻炼,恢复行走能力。
别小看这半个骨盆,苏女士接受的3D打印半骨盆复合髂腰重建手术,是西南地区首例,安装的人工半骨盆,是运用3D打印技术“量身定制”的。
确诊骨盆肿瘤3年多 用3D打印技术来做“定制”手
确诊左侧骨盆肿瘤3年多以来,苏女士辗转了多家医院治疗,花费了20多万,病情没有得到控制。半年前,在四川省人民医院就诊时,苏女士出现了大量的胸腔积液、腹腔积液,中量的心包积液,还存在慢性肾功能衰竭、高血压心脏病等多种疾病,没有办法进行手术治疗。四川省人民医院骨科副主任医师郝鹏介绍说,经过半年的治疗,苏女士的其他病情得到了控制。
从前期的影像学诊断和病理活检来看,苏女士所患的是一种恶性肿瘤,传统的治疗方案是进行手术切除、放化疗和其他的综合性治疗,其中,通过手术保证切除肿瘤的完整性,是最重要的环节,而切除后,假体的使用,也尤为关键。“之前使用的都是批量生产的假体,但肿瘤并不是长得那么‘标准’,切除肿瘤大小不一,为了配合假体,可能会多切除一部分骨头。”郝鹏介绍说,用传统的方式,手术创伤会更大、出血更多,也不利于术后康复。
恰好,今年5月,四川省人民医院与德国3D打印先锋企业签署《医学3D打印战略合作协议》,今年7月,国家药监局、国家卫生健康委发布了《定制式医疗器械监督管理规定(试行)的公告(2019年 第53号)》。每个病人具体的组织器官病灶都是独一无二的,传统的医疗器械无法真正贴合每个病人的需求。而3D打印则可以提供快速、相对低成本的器械制造,非常适合在医疗定制上进行应用。
西南地区首例!省医院为患者装上3D打印半骨盆
3D打印技术“护航”手术时间缩短3小时
“这种手术是非常复杂的,应该说是肿瘤切除中难度最大的。”郝鹏介绍说,手术前,团队为患者做了影像采集,明确了肿瘤部位、范围,设计好完整切除路径。
而经过术前精密设计与计划,大量原来术中才能进行的人工假体位置、角度、曲度调整工作放在了术前准备时完成,整个手术时间缩短了三分之一,由原来的9个多小时减少到了6个多小时。在骨科和介入科、麻醉科、手术室等多学科医护人员合作下,出血量由传统手术的1万多毫升左右减少到出血在1千毫升左右,有利于患者后期的康复。
3D打印最大的优势在于重建的假体是“量身定制”的,和患者自身的组织能够实现良好的匹配性,“我们用的是纯钛金属进行打印,它的弹性模量和它的生物相容性都是目前非常好的,是现在所有的骨头内置物最常用到的金属。”郝鹏介绍说,根据前期明确切除部位的大小,重建的组织可以完美地做到“缺多少、补多少”,3D打印可以打印出和原有骨头一样的孔隙,细节、形状,骨小梁结构放置在残骨切除面的孔隙上,骨骼“咬合”金属生长到孔隙中,从而达到非常稳定的生物重建的目的。
3D打印技术
为何最先在骨科得到突破运用
实际上,3D打印技术应用广泛,凡是需要模型和原型的行业,都可以用到3D打印技术,包括航天和国防、医疗设备、高科技、教育业以及制造业。
在医学领域,3D打印技术为什么最先在骨科得到突破和运用?郝鹏介绍说,因为骨科对于假体的要求,主要是寻求力学的支撑,3D技术可以很完美地打印出最匹配患者自身组织情况的假体形状甚至是细节,而在其他模型重建领域,例如内置物、软组织甚至是器官3D打印的研究中,要充分考虑到细胞、血管、软组织等等复杂情况,攻克难度更高。
据了解,苏女士所做的3D打印半骨盆复合髂腰重建手术,费用在11万元左右,“和普通的传统手术费用一样。”
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