3D打印个体化导板在骨肿瘤经皮穿刺活检中的初步应用  

Preliminary application of 3D printed customized guide in bone tumor biopsy

作　　者：曲扬[1,2] 艾松涛[2] 武文[1] 王磊[1] 李小敏 姜闻博[3] 郝永强[1] 戴尅戎[1] QU Yang;AI Song-tao;WU Wen;WANG Lei;LI Xiao-min;JIANG Wen-bo;HAO Yong-qiang;DAI Ke-rong(Shanghai Key Laboratory of Orthopaedic Implants,Department of Orthopaedics,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China;Department of Radiology,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China;Clinical Translational R&D Center of 3D Printing Technology,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200240,China)

机构地区：[1]上海交通大学医学院附属第九人民医院骨科,上海市骨科内植物重点实验室,上海200011 [2]上海交通大学医学院附属第九人民医院放射科,上海200011 [3]上海交通大学医学院附属第九人民医院3D打印技术临床转化研发中心,上海200240

出　　处：《上海交通大学学报（医学版）》2018年第9期1053-1058,1053,共6页Journal of Shanghai Jiao tong University:Medical Science

基　　金：国家自然科学基金(81301546);上海市教育委员会高峰高原计划(20152221);上海交通大学医学院附属第九人民医院临床研究助力计划(JYLJ025);上海交通大学医工交叉面上项目(YG2017MS03);上海交通大学医学院Ⅳ类高峰学科项目(GXQ08,GXQ11);上海交通大学医学院科技处技术转移推广项目(ZT201814);上海市科学技术委员会科技支撑项目(18441903100);上海市综合医院中西医结合专项建设(ZHYY-ZXYJHZX-1-03)。

摘　　要：目的·初步探讨基于影像图像数字化处理及3D打印技术设计的个体化导板应用于骨肿瘤经皮穿刺活检手术的可行性。方法·回顾性分析2017年7月—2018年3月以骨肿瘤诊断收治入上海交通大学医学院附属第九人民医院行活检穿刺的患者11例(男6例,女5例;年龄7~69岁,平均36岁)。术前常规行CT和MRI增强检查,DICOM数据导入Medraw Print软件,记录肿瘤的大小、位置;骨科医师明确进针方位后,依据特定骨肿瘤区域的解剖结构,设计并3D打印个体化穿刺导板。记录术中3D打印个体化导板与穿刺解剖结构匹配程度及进针位置,观察术后有无并发症。以X线或CT证实穿刺是否成功,并以开放手术的病理结果为参考标准,评估穿刺结果的准确性。结果·11例患者包括股骨4例、骨盆3例、胫骨2例、肩胛骨及掌骨各1例,3D打印个体化导板基本贴合穿刺部位解剖结构,进针方位深度均与术前设计方案一致,术中无重要解剖结构损伤,术后未出现血管、神经损伤症状。8例(88.9%)患者穿刺送检组织与术后病理良恶性结果基本一致,2例患者因穿刺活检为良性肿瘤未行骨肿瘤切除术。结论·基于影像图像数字化处理及3D打印技术设计的个性定制导板能够实现骨肿瘤的精准穿刺,对提升骨肿瘤术前诊断的准确性以及优化治疗方案具有重要意义。Objective·To explore the feasibility of applying customized guide,based on digital image processing and 3D printing technology,to bone biopsy.Methods·Eleven patients(6 males and 5 females;7-69 years old,average age of 36 years)diagnosed with bone tumor from July 2017 to March 2018 in Shanghai Ninth People's Hospital were enrolled in this study.Routine CT and/or MRI data were taken as reference in designing the customized biopsy guide for 3D printing by Medraw Print software.Needle insertion points were set under the supervision of surgeons to avoid damaging important anatomical structures such as nerves and blood vessels.3D printed customized guide was designed to match local surface.The success of the puncture was confirmed by X-ray or CT,and the accuracy of the puncture results was evaluated by the pathological results of resection operation as a reference standard.The complications were analyzed.Results·The 11 patients included 4 cases with neoplasms in femur,3 cases in pelvis,2 cases in tibia,1 case in scapula and 1 case in metacarpal.The needling positions in operation were consistent with the preoperative virtual design,and the guide plates fitted perfectly to the body surface.The results of biopsy of 8 patients(88.9%)matched with the postoperative pathology,while another 2 patients did not receive bone tumor resection because of the benign biopsy.No complications were observed during or after the procedure.Conclusion·Customized guide by digital image processing and 3D printing may have a great value in improving the accuracy of preoperative tumor diagnosis and the effectiveness of its treatment.

关 键 词：骨肿瘤 个体化穿刺导板 活检手术 3D打印技术 图像配准融合 

分 类 号：R445[医药卫生—影像医学与核医学] R738.1[医药卫生—诊断学]