开发一种新颖的3D打印机辅助方法来制造用于颅骨成形术的患者特定植入物,并证明其可行性及其在16例连续病例中的使用。
我们报告了16例连续的患者,这些患者接受了颅骨修补术,在减压手术后出现了广泛的颅骨缺损,并且没有骨瓣。我们介绍了使用3D打印机辅助成型技术进行植入物生产的工作流程。术前,术中,和术后数据进行分析/评估。
我们的16例患者中有11例(68.7%)出现广泛的半球骨缺损。初次开颅手术的指征是创伤性脑损伤(4;25%),急性硬膜下血肿(4;25%),缺血性卒中(3;18.8%),肿瘤(3;18.8%),动脉瘤破裂(2;12.5%)。中位(范围)手术时间为121(89-206)分钟。术中出血量中位数(范围)为300(100-3300)mL。平均(范围)随访期为6(0-21)个月。我们的16例患者中有7例发生并发症(43.8%),其中6例(37.5%)需要再次手术以清除轴外血肿(3;50%),用于硬膜外积液的分流(1;16.7%),或皮瓣坏死(1;16.7%)。一名患者(16.7%)出现了慢性无症状的硬膜下积液,在随访期间保持稳定。
我们在术中及时生产患者特异性植入物以覆盖颅骨缺损的工作流程被证明是可行的。结果在外观上很有吸引力,术后CT扫描显示植入物很好。由于植入式可印刷基材已经可用,我们的目标是在不久的将来推进和认证3D打印的患者专用植入物。
To develop a novel 3D-printer-assisted method to fabricate patient-specific implants for cranioplasty and to demonstrate its feasibility and its use in 16 consecutive cases.
We report on 16 consecutive patients who have undergone cranioplasty surgery for an extensive skull defect after decompressive surgery and in which the bone flap was not available. We present the workflow for the implant production using a 3D-printer-assisted molding technique. Preoperative, intraoperative, and postoperative data were analyzed/evaluated.
Eleven out of our 16 patients (68.7%) presented with extensive hemispheric bone defects. Indication for initial craniotomy were traumatic brain injury (4; 25%), acute subdural hematoma (4; 25%), ischemic stroke (3; 18.8%), tumor (3; 18.8%), and ruptured aneurysm (2; 12.5%). Median (range) operation time was 121 (89-206) minutes. Median (range) intraoperative blood loss was 300 (100-3300) mL. The mean (range) follow-up period is 6 (0-21) months. Complications occurred in 7 out of our 16 patients (43.8%), in 6 (37.5%) of which a reoperation was required to evacuate an extra-axial hematoma (3; 50%), for shunting of an epidural fluid collection (1; 16.7%), or for skin flap necrosis (1; 16.7%). One patient (16.7%) developed a chronic asymptomatic subdural fluid collection that was stable over the follow-up period.
Our workflow to intraoperatively produce patient-specific implants in a timely manner to cover cranial defects proved to be feasible. The results are cosmetically appealing, and postoperative CT scans show well-fitting implants. As implantable printable substrates are already available, we aim to advance and certify 3D-printed patient-specific implants in the near future.