3D printing technology in orthopedics

3D printing technology is a very hot word in recent years. Dr. Zeng Junjun, a volunteer doctor of Medical Science, interprets the surgical strategy of using 3D printing technology for minimally invasive laparoscopic assisted acetabular fractures.

At the beginning of this year, the team led by the Third Affiliated Hospital of Guangdong Medical University (Guangdong Provincial Orthopaedic Research Institute) applied modern high-end technology 3D printing technology to clinical orthopedics, and combined with modern minimally invasive endoscopy technology, successfully implemented. The world's first case of 3D printing to complete the preoperative simulated fracture reconstruction surgery and minimally invasive laparoscopic assisted acetabular fracture internal fixation. This technology marks China's leading level in the minimally invasive treatment of pelvic acetabular fractures.

3D printing is actually a rapid prototyping technology. It is based on digital model files and uses a bondable material such as powder metal or plastic to construct an object by layer-by-layer printing. In foreign countries, 3D printing technology has been applied in new product development, biomedical, aerospace, film and television education and other aspects, and China is mainly limited to a few fields such as mold printing and cultural and creative products. Western countries' 3D printing technology in the field of medical and health has achieved results, and it has been possible to print personalized dentures and prostheses.

Traditional acetabular fractures have large traumatic incision and reduction surgery. Generally, a 20 to 30 cm incision is made, the operation time is long, and the amount of bleeding during operation is large and the recovery is slow. The use of 3D printing technology for minimally invasive laparoscopic assisted acetabular fractures is mainly through 3D printing technology and minimally invasive techniques to improve surgical accuracy and reduce patient suffering.

The general surgical plan is: after the three-dimensional reconstruction of the patient's pelvis is simulated and reset, the patient's simulated pelvic model is printed in a ratio of 1:1 using 3D printing technology. The optimal position of the virtual surgical design steel plate and the best screw placement are obtained. Direction, and the measurement of steel plate and screw length data, the design of the screw direction navigation module and the pre-external simulation of the steel plate pre-bend, and finally the acetabular fracture internal fixation with laparoscopic assistance. All preparation work was completed, and finally the patient was officially treated with acetabular fracture internal fixation.

3D printed out and patient fully simulated pelvis

The operation was performed with laparoscopic assistance. First, four small holes of 0.5 to 2.5 cm were placed on the abdominal wall, and the laparoscope was placed in the peritoneum to establish the pneumoperitoneum. The "acetabulum fracture" was fully "exposed", and then the previous simulated operation was performed. Place the bent steel plate in the best position and drill the screws. Since the pre-operative screw length has been accurately measured according to the injured person's body, it is not necessary to repeatedly bend the steel plate and measure the screw during the operation, so that the operation time is greatly reduced. The actual internal fixation time is less than 1 hour, and the bleeding before and after is only 80 ml. If you follow the traditional procedure, the bleeding must be at least 1000 ml. Postoperative reexamination of the position of the plate and the length of the screw implantation direction were completely matched with the preoperative 3D printing simulation.

Traditional acetabular fractures open reduction surgery, because of the large incision, the recovery cycle is very long, and minimally invasive surgery due to small wounds, light pain, the patient can turn over the same day, can sit up the next day, but also avoid falling long scars. It can be seen that the use of 3D printing technology to complete the preoperative simulated fracture reconstruction surgery can greatly reduce the mistakes in the operation and reduce the pain of the patient. The use of new surgery can also greatly save blood.

The left picture shows the wound left after the traditional operation, and the right picture shows the wound left after the minimally invasive surgery.

Current 3D printing technology can print a fully simulated organ that is fully matched to the patient for surgical rehearsal. But a cutting edge in the future of 3D printing technology is to study how to print 'live' human organs. As long as you can find materials that are compatible with the human body, and then put the cells of the human body to proliferate and differentiate, you may be able to create real human tissue. However, the current printing of human organs is still only a scientific vision, which relies on breakthroughs in printed materials and technology, and requires a multidisciplinary study of biology, medicine, and computers.

Has joined the army, medical know-how volunteers. Deputy Director of Department of Trauma and Orthopaedics, the Third Affiliated Hospital of Southern Medical University, deputy chief physician, associate professor. Proficiency in the diagnosis and treatment of common diseases, frequently-occurring diseases and difficult diseases in orthopedics, the success rate of rescue for severe multiple injuries and multiple fractures is high. He has rich experience in complex pelvic and acetabular fractures, multi-segment comminuted fractures of the extremities, complex intra-articular and peripheral fractures, nonunion, and various deformity orthopedic operations. He has extensive clinical experience in traumatic orthopedic minimally invasive treatment, especially for pelvis and acetabulum. Experience in minimally invasive treatment of fractures and hip fractures in the elderly. Research direction: 1. Minimally invasive treatment of pelvic acetabular fractures. 2. Minimally invasive treatment of hip fracture in the elderly. 3. Basic and clinical studies of infectious large segmental bone defects. 4. Basic research on fracture healing and bone tissue damage repair. The core journals published more than 10 academic papers on orthopedic clinical specialty.



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