目标:为了解决复杂和翻修脊柱手术面临的解剖学挑战,针对患者的3D打印模型(3D-PM)在全球范围内受到越来越多的关注,主要是成年人。我们报告了使用3D-PM治疗VEPTR(垂直可扩展修复钛肋骨;DePuy-Synthes)系统组件上的伤口破裂的情况,需要更换Dunn-McCarthy钩和套筒,其轮廓与患者特定的3D-PM脊柱。
方法:一个两岁出生时患有脊髓膜膨出(MMC),在出生时修复,发展为进行性MMC相关的脊柱侧后凸。选择性插入肋骨至骨盆\'埃菲尔铁塔\'双侧VEPTR生长棒构建体,无初始并发症。右VEPTR套筒和Dunn-McCarthy钩左右连接器的突出导致上覆的劣质软组织破裂,需要冲洗,部分植入物移除,静脉抗生素治疗和延迟初次伤口闭合。针对患者的3D-PM,利用术前CT脊柱和骨盆3D重建,允许成形植入物的术前形成,它是在不需要进一步修订的情况下插入的。
结果:患者接受了进一步的VEPTR延长术,没有反复感染,24个月随访时伤口破裂或植入失败。随着坐姿高度和影像学指标的不断提高,畸形得到了令人满意的控制。
结论:这个案例说明了这种可能性,在某些情况下,术前使用3D-PM开发脊柱植入物系统的复杂组件,消除术中轮廓绘制的时间和难度。因此,可以生产定制轮廓的植入物,消毒和植入。这种技术可能是一种选择,在婴儿中,包括MMC相关的脊柱侧后凸,中线固定是不可能的。
OBJECTIVE: To address the anatomical challenges facing complex and revision spinal surgery, patient-specific
3D-printed models (
3D-PMs) have received growing attention worldwide, primarily in adults. We report the use of a
3D-PM in the treatment of a
case of wound breakdown over a component of a VEPTR (Vertical Expandable Prosthetic Titanium Rib; DePuy-Synthes) system, requiring replacement of Dunn-McCarthy hook and sleeve with components contoured to a patient-specific 3D-PM of the spine.
METHODS: A two-year-old born with myelomeningocele (MMC), repaired at birth, developed progressive MMC-associated kyphoscoliosis. Elective insertion of a rib-to-pelvis \'Eiffel Tower\' bilateral VEPTR growing rods construct was performed without initial complication. Prominence of the right VEPTR sleeve and Dunn-McCarthy hook side-to-side connector resulted in breakdown of overlying poor-quality soft tissues, necessitating washout, partial implant removal, intravenous antibiotic therapy and delayed primary wound closure. A patient-specific
3D-PM, utilising pre-operative CT spine and pelvis
3D-reconstructions, allowed pre-operative formation of a contoured implant, which was inserted without need for further revision.
RESULTS: The patient underwent further VEPTR lengthening without recurrent infection, wound breakdown or implant failure at 24-month follow-up. Satisfactory control of the deformity has been achieved with continued improvement in sitting height and radiographic indices.
CONCLUSIONS: This
case illustrates the possibility, in certain cases, of using
3D-PM to develop complex components of spinal implant systems pre-operatively, removing the time and difficulty of intra-operative contouring. Consequently, custom-contoured implants may be produced, sterilised and implanted. This technique may be an option, in infants, including MMC-associated kyphoscoliosis, where midline fixation is not possible.