3D打印定制颅骨“脑补”,国产化只差一步

来源:南方日报    关键词:3D打印, 医疗,    发布时间:2019-07-20

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暑假到来,儿童意外伤害又到高峰期。高空坠物砸伤了颅骨怎么办?用3D打印的特殊材料颅骨来“脑补”。

7月13日,一场3D打印与先进颅颌面创伤修复—暨天府医工交流高峰论坛在四川成都举行。这场论坛由中国增材制造产业联盟生物增材制造产业工作组主办,“新型PEEK人工修复材料”成为专家们热议的话题。

3D打印定制颅骨

2岁的小天(化名)因车祸造成颅骨缺损,人虽然抢救过来了,可当地医院说要等到6岁才能修补颅骨,最后,家长找到南方医科大学珠江医院,让孩子接受了颅骨修复手术。“儿童自身脑部仍在生长期,尤其是3岁以下孩子,脑组织会从缺损处膨出,颅骨也会发育畸形,等长大再补其实等不了。”

但目前主流的钛网修复并不适合儿童,一方面钛网粗糙容易刮破儿童娇嫩皮肤,另一方面钛网属于金属会导热,容易因太阳暴晒等烫伤皮肤。珠江医院张旺明教授介绍,最后他们为小天使用了PEEK材料3D打印的嵌入式定制颅骨,并加上了特殊改良的滑动槽,以适应儿童颅脑发育特点。

四川大学华西医院关俊文教授指出,随着我国机动车保有量逐年增加,因为交通事故导致的颅脑损伤也越来越多,颅脑损伤占全身创伤发生率第2位,但是死残率却是占据了第1位,成为严重的社会公害。除了交通意外,颅内出血、颅内肿瘤、大面积脑梗塞等疾病进行开颅手术也会导致颅骨缺损,另外,骨肿瘤等颅骨病变切除后也会导致缺损。这类病人如何救治,如何修复功能,对于神经外科来说是个永恒的话题。

颅骨修补的材料也经历了迭代。最早用人体其他部位骨头或动物骨头,19世纪末,金属材料开始用于替代颅骨。目前,金属钛网是临床上多用的颅骨修补传统材料。而随着生物医学的发展,生物材料开始在颅骨修补中一展身手。生物材料中,聚醚醚酮(俗称PEEK)是2013年经美国食品药品监督管理局批准上市的骨移植材料,是一种人工合成的高分子材料。近年来,通过3D打印定制PEEK材料的颅骨,越来越被外科医生认可。

国产版“PEEK”正在研发

使用PEEK材料修复颅骨其实早在四五年前即进入国内,但当时需要将病人的数据送到国外定制颅骨,前后必须花费将近2个月的时间,不仅费用昂贵而且费时颇久。“尤其是对于儿童患者来说,由于生长发育快,等定制颅骨送过来,可能已经与当初的缺损部位无法严丝合缝,留下一地尴尬。”

张旺明教授介绍,随着国内3D打印技术的兴起,目前已经有广州迈普等公司可以定制颅骨,并能与医生随时沟通制作过程,满足个性化需求,“价钱比原来下降了一半,最快三天即可完成。”

不过,遗憾的是,PEEK材料仍需要从国外进口,这也成为3D打印PEEK颅骨尚无法将价钱进一步降低的掣肘。

关俊文教授介绍,目前国产版的“PEEK”材料正在研发之中。“因为是用于临床,需要从毒性反应、副作用等多方面严格要求,并进行临床试验,注册也需要一定的时间。”

他透露,随着国产材料的上市,未来PEEK材料有望取代现在主流的钛网,预计未来5-10年可以达到这一目标。

离5D打印还有多远?

3D打印的PEEK颅骨,用的仍是高分子合成材料,而用细胞打印的器官,成为人类着力突破的一大方向。今年4月,以色列一个团队的研究人员用3D打印技术,利用取自病人自身的人体组织,打印出了全球第一个完整的心脏,一度引发轰动。该心脏包括细胞、血管、心腔以及心室,不过目前还无法泵血,仅能收缩。未来3D打印出人类器官用于临床手术还遥远吗?

清华大学徐弢教授的主要研究方向是细胞3D打印技术,有丰富的国外研究和产业化经验。他表示,用细胞打印被称为3D,加上神经和血管形成一个有机体,被称为4D,而要打造出有器官功能的产品,则应该称为5D。以心脏来说,目前用3D打印出外形已经可以实现,但心脏能不能正常跳动,并且根据身体需要来调动,适应身体的环境,未来还需要一个漫长的过程。
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