The Precise Surgical Treatment Of Bone Tumor With Assisting Of 3D Printing Technique

Section 1 Accuracy Verification and Clinical Application of 3D Printing ModelObjective To verify whether there was a difference between the 3D printing model based on CT data and the original anatomical structure.Retrospectively analyzed the application of 3D printing model in the past two years in our department,and discussed its application value in the surgical treatment of bone tumor.Methods Randomly selected 20 sheep femur,then marked and did 0.625 CT scan separately.The 3D printing data were reconstructed by MIMICS software and labeled in the same order as sheep femur.Exported in STL format and printed the model separately.The data of the sheep femur and the 3D printing model were measured and recorded separately.Compared the differences between the two sets of data.SPSS13.0 software for statistical analysis,the method for paired t test,P <0.05 was statistically significant.We retrospectively reviewed 53 patients who printed model in our department from December 2014 to December 2016.There were 23 males and 28 females,aged 3-78 years(mean age 39.4 years).There were 16 cases of pelvic model,23 cases of spine model,14 cases of limb model,23 cases of malignant tumor and 30 cases of benign tumor.In the 53 cases,6 cases were pringted enlarged and shrinked.The lesion was printed with the vascular nerve in 12 cases.There were 11 cases of endogenous tumor printed in two parts and 24 cases of exogenous tumor printed proportional model.Postoperative follow-up,evaluated of patients with tumor recurrence,metastasis and so on.The last follow-up was based on the MSTS functional scoring system for patients with limb bone tumors.Results The data of group Ⅰ,Ⅱ,Ⅳ and Ⅴ were compared with P <0.05.The data of group Ⅲ,Ⅵ,Ⅶ,Ⅷ and Ⅸ were compared with P> 0.05.The difference between the data of both ends of the femur was statistically significant.There was no significant difference between the data of anatomy group and the model group in the other data.All patients were followed up for 3 to 27 months with an average follow-up time of 13.8 months.Benign tumors,3 patients with tumor recurrence,to the hospital for second surgery did not find recurrence,the remaining patients with good postoperative function,no recurrence,malignant transformation and metastases,the last follow-up MSTS score 25-30 points,an average of 28.3 points.Malignant tumor patients,6 patients died(all died of tumor-related diseases),5 patients emerged of lung metastasis or other parts of multiple metastases in 2 to 24 months of postoperation,both with tumor survival,2 cases of local recurrence,the last follow-up MSTS score 16-25 points,an average of 22.4 points.Conclusions There was no significant difference between the 3D print model and its original anatomy.However,in practical applications,it needed to consider the anatomical structure,such as cartilage,soft tissue and so on.If necessary,through the combination of variety of imaging technology and accurate of three-dimensional reconstruction completed the final printing.The 3D printing model allowed us to have a clearer understanding of the scope,shape,and boundaries of the tumor,helping to clinically diagnose,better communication between the patient and the patient,and to perform an accurate operation.Section 2 The retrospective analysis of 3D printing personalized guide plateObjective Retrospectively analyzed the application of 3D printing personalized guide plate in our department over the past two years and discussed its application value in the surgical treatment of bone tumor.Methods We retrospectively reviewed 41 patients who printed personalized guide palte in our department from July 2014 to December 2016.There were 23 males and 18 females,aged 5-72 years(mean 28.6 years),11 cases of spine guide plate,16 cases of pelvic guide plate,14 cases of limb guide plate,19 cases of malignant tumor and 22 cases of benign tumor.In the 41 cases,there were 11 cases of spine screw fixation guide plate,19 cases of osteotomy guide,3 cases of percutaneous guide plate,8 cases of new acetabular guide plate.For the patients with new acetabular guide plate,X-ray and CT were performed after operation.The contrast between the ipsilateral prosthesis and the contralateral was analyzed according to X-ray and CT data.SPSS 13.0 was used for statistical analysis,P <0.05 was statistically significant.Postoperative follow-up,evaluated of patients with tumor recurrence,metastasis and so on.The last follow-up was based on the MSTS functional scoring system for patients with limb bone tumors.Results All patients were successfully conducted the design and printing of the personalized guide plate.In addition to 2 cases of guide plate in the operation of patients with intraoperative fracture transferred to conventional surgery.Slight deformation of the acetabular guide plate occurred in 1 case,and was adjusted for correct position in surgery.The rest were successfully applied the guide plate in the operation.For the patients with new acetabular guide plate,the average surgical time was 6.4 hours(range5-8.2 hours).The average blood loss was 6200 ml(range3500—9000 m1).The data comparison ofpostoperativelesion side and normal side was with no statistical significance base on the postoperative X ray and CT.All patients were followed up for 3 to 32 months with an average follow-up time of 16.5 months.Benign tumors,no recurrence,malignant transformation and metastasis,the last follow-up MSTS score were 24-29 points,an average of 27.6 points.Malignant tumor patients,4 patients died(all died of tumor-related diseases),3 patients emerged of lung metastasis or other parts of multiple metastases in 4 to 20 months of postoperation,both with tumor survival,2 cases of local recurrence,the last follow-up MSTS score 14-26 points,an average of 21.7 points.Conclusion The 3D printing personalized guide plate,made us to achieve the intraoperative precision osteotomy and screw fixation operation,while reducing the overall trauma for the patients in the surgery.The application of 3D printing acetabulum guide plate which could assist the installation of acetabular cup in the right location,reduce the operation time,blood loss and number of perspective of the operation with accurate acetabulum position in the postoperative evaluation had certain innovation and functional effectiveness.Section 3 The Clinical Application of 3D printing personalized Customized ProsthesisObjective Retrospectively analyzed the application of 3D printing personalized implanted metal prosthesis in recent years in our department,and discussed its application value in the surgical treatment of large segment of bone defects in bone tumor.Methods We retrospectively reviewed 13 patients who printed personalized implanted metal prosthesis and operated in our department from January 2014 to December 2016.There were 5 males and 8 females,aged 6 to 65 years,mean 33.5 years old,1 case of chondrosarcoma,1 case of PNET,1 case of osteosarcoma,3 cases of Ewing sarcoma,3 cases of giant cell tumor of bone,1 case of chondromioblastoma,1 case of osteoblastoma,1 case of pleomorphic sarcoma,1 case of lung cancer bone metastasis.All patients were diagnosed by preoperative biopsy or outside biopsy results had our hospital pathology consultation.All Ewing sarcomas and common osteosarcoma were conducted preoperative neoadjuvant chemotherapy.All patients were signed ―Xijing Hospital orthopedic metal 3D printing prosthesis implantation informed consent‖.Followed up to evaluate whether patients with recurrence,metastasis and their limb function.The last follow-up was based on the MSTS functional scoring system for patients with limb bone tumors.Result All patients were successfully designed and printed personalized metal prosthesis,and successfully completed the operation,postoperative review X-ray showed a good fixed position of the prosthesis.The average operation time was 269.6min,the average blood loss was 1369.2ml,and there was no complication in and after operation.All patients were followed up for 3 to 32 months with an average follow-up time of 17.6 months.All patients survived,2 cases with lung metastasis after 3 months of the operation,both survival,1 case of local tumor recurrence,1 case of patients with local pain then removal of the prosthesis.The remaining tumor recurrence and metastasis were not found.The last follow-up MSTS score of 15-27 points,an average of 23.3 points.Conclusion The application of 3D personalized titanium alloy metal implants in patients with large bone defects after resection of bone tumors was a good solution to the problems of previous autogenous bone,allogeneic bone deficiency,and lack of matching in prosthesis reconstruction.Through elaborate design of 3D printing personalized titanium alloy prosthesis,at the same time according to the needs of composite fibular flap or artificial bone reconstruction,achieved the exact reconstruction of bone defects after the resection of tumor,but also had a certain biological activity.It made a good effect in the clinical,and had a very good application prospects.