USE OF FOUR KINDS OF THREE-DIMENSIONAL PRINTING GUIDE PLATE IN BONE TUMOR RESECTION AND RECONSTRUCTION OPERATION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

FUJun ,  GUOZheng , WANGZhen , LIXiangdong , FANHongbin , LIJing , PEIYanjun , PEIGuoxian , LIDan

Department of Orthopaedics, Xijing Hospital, the Fourth Military Medical University, Xi'an Shaanxi, 710032, P. R. China;

Corresponding author：

GUOZheng, Email: guozheng@fmmu.edu.cn

Keywords：

Three-dimensional printing technique; Operation guide plate; Bone tumor; Repair and reconstruction

DOI：

10.7507/1002-1892.20140069

Video：

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Objective To explore the effectiveness of excision and reconstruction of bone tumor by using operation guide plate made by variety of three-dimensional (3-D) printing techniques, and to compare the advantages and disadvantages of different 3-D printing techniques in the manufacture and application of operation guide plate. Methods Between September 2012 and January 2014, 31 patients with bone tumor underwent excision and reconstruction of bone tumor by using operation guide plate. There were 19 males and 12 females, aged 6-67 years (median, 23 years). The disease duration ranged from 15 days to 12 months (median, 2 months). There were 13 cases of malignant tumor and 18 cases of benign tumor. The tumor located in the femur (9 cases), the spine (7 cases), the tibia (6 cases), the pelvis (5 cases), the humerus (3 cases), and the fibula (1 case). Four kinds of 3-D printing technique were used in processing operation guide plate:fused deposition modeling (FDM) in 9 cases, stereo lithography appearance (SLA) in 14 cases, 3-D printing technique in 5 cases, and selective laser sintering (SLS) in 3 cases; the materials included ABS resin, photosensitive resin, plaster, and aluminum alloy, respectively. Before operation, all patients underwent thin layer CT scanning (0.625 mm) in addition to conventional imaging. The data were collected for tumor resection design, and operation guide plate was designed on the basis of excision plan. Preoperatively, the operation guide plates were made by 3-D printing equipment. After sterilization, the guide plates were used for excision and reconstruction of bone tumor. The time of plates processing cycle was recorded to analyse the efficiency of 4 kinds of 3-D printing techniques. The time for design and operation and intraoperative fluoroscopy frequency were recorded. Twenty-eight patients underwent similar operations during the same period as the control group. Results The processing time of operation guide plate was (19.3±6.5) hours in FDM, (5.2±1.3) hours in SLA, (8.6±1.9) hours in 3-D printing technique, and (51.7±12.9) hours in SLS. The preoperative design and operation guide plate were successfully made, which was used for excision and reconstruction of bone tumor in 31 cases. Except 3 failures (operation guide plate fracture), the resection and reconstruction operations followed the preoperative design in the other 28 cases. The patients had longer design time, shorter operation time, and less fluoroscopy frequency than the patients of the control group, showing significant differences (P<0.05). The follow-up time was 1-12 months (mean, 3.7 months). Postoperative X-ray and CT showed complete tumor resection and stable reconstruction. Conclusion 3-D printing operation guide plates are well adapted to the requirements of individual operation for bone tumor resection and reconstruction. The 4 kinds of 3-D printing techniques have their own advantages and should be chosen according to the need of operation.

Citation： FUJun, GUOZheng, WANGZhen, LIXiangdong, FANHongbin, LIJing, PEIYanjun, PEIGuoxian, LIDan. USE OF FOUR KINDS OF THREE-DIMENSIONAL PRINTING GUIDE PLATE IN BONE TUMOR RESECTION AND RECONSTRUCTION OPERATION. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(3): 304-308. doi: 10.7507/1002-1892.20140069 Copy

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5.	李惠忠, 扬光. 定位导向模板结合CT图像在牙种植外科的应用. 中国口腔颌面外科杂志, 2008, 13(4):189-191.
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8.	Mazzoni S, Marchetti C, Sgarzani R, et al. Prosthetically guided maxillofacial surgery:evaluation of the accuracy of a surgical guide and custom-made bone plate in oncology patients after mandibular reconstruction. Plast Reconstr Surg, 2013, 131(6):1376-1385.
9.	Ciocca L, Mazzoni S, Fantini M, et al. CAD/CAM guided secondary mandibular reconstruction of a discontinuity defect after ablative cancer surgery. J Craniomaxillofac Surg, 2012, 40(8):e511-515.
10.	Ciocca L, Mazzoni S, Fantini M, et al. A CAD/CAM-prototyped anatomical condylar prosthesis connected to a custom-made bone plate to support a fibula free flap. Med Biol Eng Comput, 2012, 50(7):743-749.
11.	Levine JP, Patel A, Saadeh PB, et al. Computer-aided design and manufacturing in craniomaxillofacial surgery:the new state of the art. J Craniofac Surg, 2012, 23(1):288-293.
12.	陆声, 徐永清, 张元智, 等. 计算机辅助导航模板在下颈椎椎弓根定位中的临床应用. 中华骨科杂志, 2008, 28(12):1002-1007.
13.	张元智, 陆声, 杨勇, 等. 计算机辅助设计截骨导航模板治疗肘内翻畸形的初步应用. 中华小儿外科杂志, 2010, 31(3):180-182.
14.	Kunz M, Ma B, Rudan JF, et al. Image-guided distal radius osteotomy using patient-specific instrument guides. J Hand Surg (Am), 2013, 38(8):1618-1624.
15.	Tricot M, Duy KT, Docquier PL. 3D-corrective osteotomy using surgical guides for posttraumatic distal humeral deformity. Acta Orthop Belg, 2012, 78(4):538-542.
16.	Thomas CV, McMillan KG, Jeynes P, et al. Use of a titanium cutting guide to assist raising the composite radial forearm free flap. Int J Oral Maxillofac Surg, 2013, 42(11):1414-1417.

1. Takeyasu Y, Oka K, Miyake J, et al. Preoperative, computer simulation-based, three-dimensional corrective osteotomy for cubitus varus deformity with use of a custom-designed surgical device. J Bone Joint Surg (Am), 2013, 95(22):e173.
2. Dérand P, Rännar LE, Hirsch JM. Imaging, virtual planning, design, and production of patient-specific implants and clinical validation in craniomaxillofacial surgery. Craniomaxillofac Trauma Reconstr, 2012, 5(3):137-144.
3. 王臻, 滕勇, 李涤尘, 等. 基于快速成型的个体化人工半膝关节的研制——计算机辅助设计与制造. 中国修复重建外科杂志, 2004, 18(5):347-351.
4. 史俊, 徐兵, 唐友盛, 等. 个体化复位模板在颧骨复合体骨折治疗中的应用. 中国口腔颌面外科杂志, 2005, 3(4):311-314.
5. 李惠忠, 扬光. 定位导向模板结合CT图像在牙种植外科的应用. 中国口腔颌面外科杂志, 2008, 13(4):189-191.
6. Omori S, Murase T, Kataoka T, et al. Three-dimensional corrective osteotomy using a patient-specific osteotomy guide and bone plate based on a computer simulation system:accuracy analysis in a cadaver study. Int J Med Robot, 2013.[Epub ahead of print].
7. 付军, 郭征, 王臻, 等. 数字骨库的建立及其在骨肿瘤手术治疗中的应用. 中华创伤骨科杂志, 2013, 15(1):55-59.
8. Mazzoni S, Marchetti C, Sgarzani R, et al. Prosthetically guided maxillofacial surgery:evaluation of the accuracy of a surgical guide and custom-made bone plate in oncology patients after mandibular reconstruction. Plast Reconstr Surg, 2013, 131(6):1376-1385.
9. Ciocca L, Mazzoni S, Fantini M, et al. CAD/CAM guided secondary mandibular reconstruction of a discontinuity defect after ablative cancer surgery. J Craniomaxillofac Surg, 2012, 40(8):e511-515.
10. Ciocca L, Mazzoni S, Fantini M, et al. A CAD/CAM-prototyped anatomical condylar prosthesis connected to a custom-made bone plate to support a fibula free flap. Med Biol Eng Comput, 2012, 50(7):743-749.
11. Levine JP, Patel A, Saadeh PB, et al. Computer-aided design and manufacturing in craniomaxillofacial surgery:the new state of the art. J Craniofac Surg, 2012, 23(1):288-293.
12. 陆声, 徐永清, 张元智, 等. 计算机辅助导航模板在下颈椎椎弓根定位中的临床应用. 中华骨科杂志, 2008, 28(12):1002-1007.
13. 张元智, 陆声, 杨勇, 等. 计算机辅助设计截骨导航模板治疗肘内翻畸形的初步应用. 中华小儿外科杂志, 2010, 31(3):180-182.
14. Kunz M, Ma B, Rudan JF, et al. Image-guided distal radius osteotomy using patient-specific instrument guides. J Hand Surg (Am), 2013, 38(8):1618-1624.
15. Tricot M, Duy KT, Docquier PL. 3D-corrective osteotomy using surgical guides for posttraumatic distal humeral deformity. Acta Orthop Belg, 2012, 78(4):538-542.
16. Thomas CV, McMillan KG, Jeynes P, et al. Use of a titanium cutting guide to assist raising the composite radial forearm free flap. Int J Oral Maxillofac Surg, 2013, 42(11):1414-1417.

Chinese Journal of Reparative and Reconstructive Surgery

USE OF FOUR KINDS OF THREE-DIMENSIONAL PRINTING GUIDE PLATE IN BONE TUMOR RESECTION AND RECONSTRUCTION OPERATION

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