Objective To explore the application effect of 3D printed heart models in the training of young cardiac surgeons, and evaluate their application value in surgical simulation and skill improvement. MethodsEight young cardiac surgeons were selected form West China Hospital as the trainees. Before training, the Hands-On Surgical Training-Congenital Heart Surgery (HOST-CHS) operation scores of the 8 cardiac surgeons were obtained after operating on 2 pig heart models of ventricular septal defect (VSD). Subsequently, simulation training was conducted on a 3D printed peri-membrane VSD heart model for 6 weeks, once a week. After the training, all trainees completed 2 pig heart VSD repair surgeries. The improvement of doctors’ skills was evaluated through survey questionnaires, HOST-CHS scores, and operation time after training. ResultsBefore the training, the average HOST-CHS score of the 8 trainees was 52.2±6.3 points, and the average time for VSD repair was 54.7±7.1 min. During the 6-week simulation training using 3D printed models, the total score of HOST-CHS for the 8 trainees gradually increased (P<0.001), and the time required to complete VSD repair was shortened (P<0.001). The trainees had the most significant improvement in scores of surgical cognition and protective awareness. The survey results showed that trainees were generally very satisfied with the effectiveness of 3D model simulation training. Conclusion The 3D printed VSD model demonstrates significant application advantages in the training of young cardiac surgeons. By providing highly realistic anatomical structures, 3D models can effectively enhance surgeons’ surgical skills. It is suggested to further promote the application of 3D printing technology in medical education, providing strong support for cultivating high-quality cardiac surgeons.
Objective To explore the effectiveness of computer-aided technology in the treatment of primary elbow osteoarthritis combined with stiffness under arthroscopy. Methods The clinical data of 32 patients with primary elbow osteoarthritis combined with stiffness between June 2018 and December 2020 were retrospectively analyzed. There were 22 males and 10 females with an average age of 53.4 years (range, 31-71 years). X-ray film and three-dimensional CT examinations showed osteophytes of varying degrees in the elbow joint. Loose bodies existed in 16 cases, and there were 7 cases combined with ulnar nerve entrapment syndrome. The median symptom duration was 2.5 years (range, 3 months to 22.5 years). The location of bone impingement from 0° extension to 140° flexion of the elbow joint was simulated by computer-aided technology before operation and a three-dimensional printed model was used to visualize the amount and scope of impinging osteophytes removal from the anterior and posterior elbow joint to accurately guide the operation. Meanwhile, the effect of elbow joint release and impinging osteophytes removal was examined visually under arthroscopy. The visual analogue scale (VAS) score, Mayo elbow performance score (MEPS), and elbow range of motion (extension, flexion, extension and flexion) were compared between before and after operation to evaluate elbow function. Results The mean operation time was 108 minutes (range, 50-160 minutes). All 32 patients were followed up 9-18 months with an average of 12.5 months. There was no other complication such as infection, nervous system injury, joint cavity effusion, and heterotopic ossification, except 2 cases with postoperative joint contracture at 3 weeks after operation due to the failure to persist in regular functional exercises. Loose bodies of elbow and impinging osteophytes were removed completely for all patients, and functional recovery was satisfactory. At last follow-up, VAS score, MEPS score, extension, flexion, flexion and extension range of motion significantly improved when compared with preoperative ones (P<0.05). Conclusion Arthroscopic treatment of primary elbow osteoarthritis combined with stiffness using computer-aided technology can significantly reduce pain, achieve satisfactory functional recovery and reliable effectiveness.
ObjectiveTo investigate the effectiveness of digital three-dimensional (3D) printing osteotomy guide plate assisted total knee arthroplasty (TKA) in treatment of knee osteoarthritis (KOA) patients with femoral internal implants. Methods The clinical data of 55 KOA patients who met the selection criteria between July 2021 and October 2023 were retrospectively analyzed. Among them, 26 cases combined with femoral implants were treated with digital 3D printing osteotomy guide plate assisted TKA (guide plate group), and 29 cases were treated with conventional TKA (control group). There was no significant difference in gender, age, body mass index, side, Kellgren-Lawrence classification, preoperative visual analogue scale (VAS) score, Hospital for Special Surgery (HSS) knee score, knee range of motion, and other baseline data between the two groups (P>0.05). The operation time, intraoperative blood loss, incision length, postoperative first ambulation time, surgical complications; VAS score, knee HSS score, knee range of motion before operation, at 1 week and 3 months after operation, and at last follow-up; distal femoral lateral angle, proximal tibial medial angle, hip-knee-ankle angle and other imaging indicators at last follow-up were recorded and compared between the two groups. ResultsThe operation time, incision length, intraoperative blood loss, and postoperative first ambulation time in the guide plate group were significantly lower than those in the control group (P<0.05). In the control group, there were 1 case of incision rupture and bleeding and 1 case of lower limb intermuscular venous thrombosis, which was cured after symptomatic treatment. There was no complication such as neurovascular injury, incision infection, or knee prosthesis loosening in both groups. Patients in both groups were followed up 12-26 months, with an average of 16.25 months. The VAS score, HSS score, and knee range of motion improved at each time point after operation in both groups, and further improved with time after operation, the differences were significant (P<0.05). The above indicators in the guide plate group were significantly better than those in the control group at 1 week and 3 months after operation (P<0.05), and there was no significant difference between the two groups at last follow-up (P>0.05). At last follow-up, the distal femoral lateral angle, the proximal tibial medial angle, and the hip-knee-ankle angle in the guide plate group were significantly better than those in the control group (P<0.05). Conclusion The application of digital 3D printing osteotomy guide plate assisted TKA in the treatment of KOA patients with femoral implants can simplify the surgical procedures, overcome limitations of conventional osteotomy guides, reduce surgical trauma, achieve individualized and precise osteotomy, and effectively restore lower limb alignment and knee joint function.
Objective To investigate the construction of a novel tissue engineered meniscus scaffold based on low temperature deposition three-dimenisonal (3D) printing technology and evaluate its biocompatibility. Methods The fresh pig meniscus was decellularized by improved physicochemical method to obtain decellularized meniscus matrix homogenate. Gross observation, HE staining, and DAPI staining were used to observe the decellularization effect. Toluidine blue staining, safranin O staining, and sirius red staining were used to evaluate the retention of mucopolysaccharide and collagen. Then, the decellularized meniscus matrix bioink was prepared, and the new tissue engineered meniscus scaffold was prepared by low temperature deposition 3D printing technology. Scanning electron microscopy was used to observe the microstructure. After co-culture with adipose-derived stem cells, the cell compatibility of the scaffolds was observed by cell counting kit 8 (CCK-8), and the cell activity and morphology were observed by dead/live cell staining and cytoskeleton staining. The inflammatory cell infiltration and degradation of the scaffolds were evaluated by subcutaneous experiment in rats. Results The decellularized meniscus matrix homogenate appeared as a transparent gel. DAPI and histological staining showed that the immunogenic nucleic acids were effectively removed and the active components of mucopolysaccharide and collagen were remained. The new tissue engineered meniscus scaffolds was constructed by low temperature deposition 3D printing technology and it had macroporous-microporous microstructures under scanning electron microscopy. CCK-8 test showed that the scaffolds had good cell compatibility. Dead/live cell staining showed that the scaffold could effectively maintain cell viability (>90%). Cytoskeleton staining showed that the scaffolds were benefit for cell adhesion and spreading. After 1 week of subcutaneous implantation of the scaffolds in rats, there was a mild inflammatory response, but no significant inflammatory response was observed after 3 weeks, and the scaffolds gradually degraded. Conclusion The novel tissue engineered meniscus scaffold constructed by low temperature deposition 3D printing technology has a graded macroporous-microporous microstructure and good cytocompatibility, which is conducive to cell adhesion and growth, laying the foundation for the in vivo research of tissue engineered meniscus scaffolds in the next step.
ObjectiveTo review research progress on the design, manufacturing, and clinical application of three-dimensional (3D) printed customized prosthesis in acetabular reconstruction of hip revision surgery. MethodsThe related research literature on 3D printed customized prosthesis and its application in acetabular reconstruction of hip revision surgery was searched by key words of “3D printed customized prosthesis”, “revision hip arthroplasty”, “acetabular bone defect”, and “acetabular reconstruction” between January 2013 and May 2024 in Chinese and English databases, such as CNKI, Wanfang database, PubMed, etc. A total of 34 271 articles were included. After reading the literature titles, abstracts, or full texts, the literature of unrelated, repetitive, low-quality, and low evidence level was screened out, and a total of 48 articles were finally included for analysis and summary. ResultsThe bone growth and mechanical properties of 3D printed customized prosthesis materials are better than those of non-3D printed customized prosthesis, which further solves the problem of elastic modulus mismatch between the implant and natural bone caused by “stress shielding”; the porous structure and antibacterial coating on the surface of 3D printed customized prosthesis have good anti-bacterial effect. 3D printed customized prosthesis can perfectly match the patient’s individual acetabular anatomical characteristics and defect type, thus improving the accuracy of acetabular reconstruction and reducing the surgical time and trauma. Conclusion3D printed customized prosthesis can be used for precise and efficient individualized acetabular reconstruction in hip revision surgery with good early- and mid-term effectiveness. More optimized production technics and procedures need to be developed to improve the efficiency of clinical application and long-term effectiveness.
ObjectiveTo study the feasibility of preparation of the individualized femoral prosthesis through computer assisted design and electron beammelting rapid prototyping (EBM-RP) metal three-dimensional (3D) printing technology. MethodsOne adult male left femur specimen was used for scanning with 64-slice spiral CT; tomographic image data were imported into Mimics15.0 software to reconstruct femoral 3D model, then the 3D model of individualized femoral prosthesis was designed through UG8.0 software. Finally the 3D model data were imported into EBM-RP metal 3D printer to print the individualized sleeve. ResultsAccording to the 3D model of individualized prosthesis, customized sleeve was successfully prepared through the EBM-RP metal 3D printing technology, assembled with the standard handle component of SR modular femoral prosthesis to make the individualized femoral prosthesis. ConclusionCustomized femoral prosthesis accurately matching with metaphyseal cavity can be designed through the thin slice CT scanning and computer assisted design technology. Titanium alloy personalized prosthesis with complex 3D shape, pore surface, and good matching with metaphyseal cavity can be manufactured by the technology of EBM-RP metal 3D printing, and the technology has convenient, rapid, and accurate advantages.
Objective To explore the application progress and clinical value of digital technologies in the surgical treatment of ankylosing spondylitis (AS). Methods By systematically reviewing domestic and international literature, the study summarized the specific application scenarios, operational procedures, and technical advantages of digital technologies [including preoperative three-dimensional (3D) planning, intraoperative real-time navigation, robot-assisted surgery, and 3D printing] in AS surgery, and analyzed their impact on surgical accuracy, complication rates, and clinical outcomes. ResultsDigital technologies significantly improve the precision and safety of AS surgery. Preoperative 3D planning enables personalized surgical protocols; intraoperative navigation systems dynamically adjusts surgical trajectories, reducing the risk of iatrogenic injury; robot-assisted surgery can minimize human errors and enhance implant positioning accuracy; 3D-printed anatomical models and guides optimize the correction of complex spinal deformities. Furthermore, the combined applications of these technologies shorten operative time, reduce intraoperative blood loss, decrease postoperative complications (e.g., infection, nerve injury), and accelerate functional recovery.ConclusionThrough multidimensional integration and innovation, digital technologies provide a precise and minimally invasive solution for AS surgical treatment. Future research should focus on their synergy with biomaterials and intelligent algorithms to further refine surgical strategies and improve long-term prognosis.
Objective To investigate the effectiveness of using 3 hollow compression screws combined with 1 screw off-axis fixation under the guidance of three-dimensional (3D) printed guide plate with mortise-tenon joint structure (mortise-tenon joint plate) for the treatment of Pauwels type Ⅲ femoral neck fractures. Methods A clinical data of 78 patients with Pauwels type Ⅲ femoral neck fractures, who were admitted between August 2022 and August 2023 and met the selection criteria, was retrospectively analyzed. The operations were assisted with mortise-tenon joint plates in 26 cases (mortise-tenon joint plate group) and traditional guide plates in 28 cases (traditional plate group), and without guide plates in 24 cases (control group). There was no significant difference in the baseline data of gender, age, body mass index, cause of injury, and fracture side between groups (P>0.05). The operation time, intraoperative blood loss, frequency of intraoperative fluoroscopy, incision length, incidence of postoperative deep vein thrombosis of lower extremity, pain visual analogue scale (VAS) score at 1 week after operation, and Harris score of hip joint at 3 months after operation were recorded and compared. X-ray re-examination was taken to check the quality of fracture reduction, fracture healing, and the shortening length of the femoral neck at 3 months after operation, and the incidences of internal fixation failure and osteonecrosis of the femoral head during operation. Results Compared with the control group, the operation time, intraoperative blood loss, and frequency of intraoperative fluoroscopy reduced in the two plate groups, and the quality of fracture reduction was better, but the incision was longer, and the differences were significant (P<0.05). The operation time and intraoperative blood loss were significantly higher in the traditional plate group than in the mortise-tenon joint plate group (P<0.05), the incision was significantly longer (P<0.05); and the difference in fracture reduction quality and the frequency of intraoperative fluoroscopy was not significant between two plate groups (P>0.05). There was 1 case of deep vein thrombosis of lower extremity in the traditional plate group and 1 case in the control group, while there was no thrombosis in the mortise-tenon joint plate group. There was no significant difference in the incidence between groups (P>0.05). All patients were followed up 12-15 months (mean, 13 months). There was no significant difference in VAS score at 1 week and Harris score at 3 months between groups (P>0.05). Compared with the control group, the fracture healing time and the length of femoral neck shortening at 3 months after operation were significantly shorter in the two plate groups (P<0.05). There was no significant difference between the two plate groups (P>0.05). There was no significant difference in the incidences of non-union fractures, osteonecrosis of the femoral head, or internal fixation failure between groups (P>0.05). Conclusion For Pauwels type Ⅲ femoral neck fractures, the use of 3D printed guide plate assisted reduction and fixation can shorten the fracture healing time, reduce the incidence of postoperative complications, and be more conducive to the early functional exercise of the affected limb. Compared with the traditional guide plate, the mortise-tenon joint plate can reduce the intraoperative bleeding and shorten the operation time.
Objective To explore the surgical skills of modified Gibson combined with modified ilioinguinal (MGMII) approach in the treatment of Enneking Ⅱ+Ⅲ pelvic malignant tumors in the three-dimensional (3D) printed customized integrated hemipelvic prosthesis, and to evaluate the convenience and accuracy of the surgical approach and the short-term effectiveness. Methods Between January 2017 and March 2019, 7 patients with Enneking Ⅱ+Ⅲ pelvic malignant tumors were treated with tumor resection and 3D printed hemipelvic prosthesis replacement via MGMII approach. There were 6 males and 1 female. The age ranged from 23 to 68 years, with an average of 43.7 years. There was 1 chondrosarcoma, 1 Ewing’s sarcoma, 1 osteosarcoma, 1 malignant Schwannoma, 2 metastatic renal clear cell carcinoma, and 1 metastatic hepatocellular carcinoma. The Enneking stage of 4 cases of primary malignant tumor was stage ⅡB. The disease duration was 6-12 months, with an average of 9.5 months. The preoperative Harris hip score (HHS) was 82.1±1.4 and the Musculoskeletal Tumor Society (MSTS) score was 21.4±1.1. The tumor size by imaging examination was 5.1-9.1 cm, with an average of 6.9 cm. The operation time, intraoperative blood loss, postoperative blood transfusion volume, and postoperative complications were recorded. Postoperative pathological examination confirmed tumor residue according to R classification criteria. The lower limb length, acetabular height, acetabular eccentricity, abduction angle, and anteversion angle were measured and the bone integration was observed by imaging review. Bilateral abductor muscle strengths were measured, and joint function was evaluated by MSTS score and HHS score. Results All operations were successfully completed. The operation time was 210-360 minutes (mean, 280.0 minutes); the intraoperative blood loss was 1 300-2 500 mL (mean, 1 785.7 mL); the postoperative blood transfusion volume was 0-11 U (mean, 6.1 U). Postoperative pathological examination confirmed R0 resection assisted by osteotomy guide plate. All incisions healed by first intention. All patients were followed up 30-48 months (mean, 41.3 months). At last follow-up, the imaging review showed the good osseointegration in all 7 cases. There was no significant difference in the lower limb length, acetabular height, acetabular eccentricity, abduction angle, and anteversion angle between the affected side and the healthy side (P>0.05), all of which met the requirements of anatomical reconstruction. At 3 months after operation, the ratios of muscle strength between the affected side and the healthy side was 68.29%±7.41% at 3 months and 89.86%±2.79% at 12 months, showing a significant difference between the two time points (t=8.242, P=0.000). At last follow-up, the MSTS score and HHS score were 27.3±0.8 and 96.6±1.4, respectively, which significantly improved when compared with those before operation (P<0.05). None of the patients had assisted walking at last follow-up. There was no recurrence, death, or complications such as deep infection, dislocation of the prosthesis, or fracture of the prosthesis or screw. Conclusion MGMII approach can expose the posterior column of the acetabulum, especially the ischial tubercle, which is helpful to avoid tumor rupture during tumor resection and preserve the muscle functions such as gluteus medius and iliac muscle while ensuring the resection scope.