ObjectiveTo manufacture a polycaprolactone (PCL)/type Ⅰ collagen (COL Ⅰ) tissue engineered meniscus scaffold (hereinafter referred to as PCL/COL Ⅰ meniscus scaffold) by three-dimensional (3D) printing with low temperature deposition technique and to study its physicochemical properties.MethodsFirst, the 15% PCL/4% COLⅠ composite solution and 15% PCL simple solution were prepared. Then, 15% PCL/4% COL Ⅰmeniscus scaffold and 15% PCL meniscal scaffold were prepared by using 3D printing with low temperature deposition techniques. The morphology and microstructure of the scaffolds were observed by gross observation and scanning electron microscope. The compression modulus and tensile modulus of the scaffolds were measured by biomechanical test. The components of the scaffolds were analyzed by Fourier transform infrared spectroscopy (FTIR). The contact angle of the scaffold surface was measured. The meniscus cells of rabbits were cultured with the two scaffold extracts and scaffolds, respectively. After cultured, the cell proliferations were detected by cell counting kit 8 (CCK-8), and the normal cultured cells were used as controls. Cell adhesion and growth of scaffold-cell complex were observed by scanning electron microscope.ResultsAccording to the gross and scanning electron microscope observations, two scaffolds had orientated 3D microstructures and pores, but the surface of the PCL/COLⅠ meniscus scaffold was rougher than the PCL meniscus scaffold. Biomechanical analysis showed that the tensile modulus and compression modulus of the PCL/COL Ⅰ meniscus scaffold were not significantly different from those of the PCL meniscus scaffold (P>0.05). FTIR analysis results showed that COL Ⅰ and PCL were successful mixed in PCL/ COL Ⅰ meniscus scaffolds. The contact angle of PCL/COLⅠ meniscus scaffold [(83.19±7.49)°] was significantly lower than that of PCL meniscus scaffold [(111.13±5.70)°] (t=6.638, P=0.000). The results of the CCK-8 assay indicated that with time, the number of cells cultured in two scaffold extracts showed an increasing trend, and there was no significant difference when compared with the control group (P>0.05). Scanning electron microscope observation showed that the cells attached on the PCL/ COL Ⅰ meniscus scaffold more than that on the PCL scaffold.ConclusionPCL/COLⅠmeniscus scaffolds are prepared by 3D printing with low temperature deposition technique, which has excellent physicochemical properties without cytotoxicity. PCL/COLⅠmeniscus scaffold is expected to be used as the material for meniscus tissue engineering.
ObjectiveTo explore the gait trajectory characteristics of patients after total knee arthroplasty (TKA) assisted by three-dimensional (3D) printing navigation template.MethodsTwenty female patients (20 knees) with knee osteoarthritis who were treated with TKA assisted by 3D printing navigation template between February 2017 and February 2018 were selected as the 3D printing group. The patients were 50-69 years old, with an average age of 57.2 years. The disease duration was 4-7 years, with an average of 5.6 years. The osteoarthritis was classified as Kellgren-Lawrence Ⅲ level in 5 cases and Ⅳ level in 15 cases. The preoperative hip-knee-ankle angle (HKA) was (170.8±5.6)°. All patients were varus deformity. According to age and affected side, 20 healthy female volunteers were selected as the control group. The volunteers were 51-70 years old, with an average age of 56.7 years. Preoperative HKA was (178.8±0.6)°. There was significant difference in HKA between the two groups (P>0.05). The HKA, Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and visual analogue scale (VAS) scores of the 3D printing group before and after operation were compared. At 6 months after operation, the gait trajectory characteristics of 3D printing group and control group were analyzed by Vicon gait capture system. The kinematics parameters included velocity, cadence, stride length, maximum knee flexion angle (stance), minimum knee flexion angle (stance), maximum knee flexion angle (swing), mean hip rotation angle (stance), mean ankle rotation angle (stance).ResultsThe incisions of 3D printing group healed by first intention, with no complications. All patients were followed up 7-12 months (mean, 9.0 months). The WOMAC and VAS scores at 6 months after operation were significant lower than those before operation (P<0.05). The HKA was (178.8±0.8)° at 4 weeks after operation and the difference was significant when compared with that before operation (t=39.203, P=0.000). The position of the prosthesis was good. The femoral posterior condyle osteotomy line, surgical transepicondylar axis, and patella transverse line were parallel, varus deformity was corrected, and lower limb alignment was restored to neutral position. Gait analysis at 6 months after operation showed that the differences in all kinematics parameters between the two groups were significant (P<0.05).ConclusionAssisted by 3D printing navigation template, TKA can alleviate pain symptoms and correct deformity, with satisfactory early effectiveness. Compared with healthy people, the early postoperative gait of the patients were characterized by decreasing velocity, cadence, stride length, knee flexion range, and increasing compensatory hip and ankle rotation range.
ObjectiveTo evaluate the application value of three-dimensional (3D) reconstruction in preoperative surgical diagnosis of new classification criteria for lung adenocarcinoma, which is helpful to develop a deep learning model of artificial intelligence in the auxiliary diagnosis and treatment of lung cancer.MethodsThe clinical data of 173 patients with ground-glass lung nodules with a diameter of ≤2 cm, who were admitted from October 2018 to June 2020 in our hospital were retrospectively analyzed. Among them, 55 were males and 118 were females with a median age of 61 (28-82) years. Pulmonary nodules in different parts of the same patient were treated as independent events, and a total of 181 subjects were included. According to the new classification criteria of pathological types, they were divided into pre-invasive lesions (atypical adenomatous hyperplasia and and adenocarcinoma in situ), minimally invasive adenocarcinoma and invasive adenocarcinoma. The relationship between 3D reconstruction parameters and different pathological subtypes of lung adenocarcinoma, and their diagnostic values were analyzed by multiplanar reconstruction and volume reconstruction techniques.ResultsIn different pathological types of lung adenocarcinoma, the diameter of lung nodules (P<0.001), average CT value (P<0.001), consolidation/tumor ratio (CTR, P<0.001), type of nodules (P<0.001), nodular morphology (P<0.001), pleural indenlation sign (P<0.001), air bronchogram sign (P=0.010), vascular access inside the nodule (P=0.005), TNM staging (P<0.001) were significantly different, while nodule growth sites were not (P=0.054). At the same time, it was also found that with the increased invasiveness of different pathological subtypes of lung adenocarcinoma, the proportion of dominant signs of each group gradually increased. Meanwhile, nodule diameter and the average CT value or CTR were independent risk factors for malignant degree of lung adenocarcinoma.ConclusionImaging signs of lung adenocarcinoma in 3D reconstruction, including nodule diameter, the average CT value, CTR, shape, type, vascular access conditions, air bronchogram sign, pleural indenlation sign, play an important role in the diagnosis of lung adenocarcinoma subtype and can provide guidance for personalized therapy to patients in clinics.
Reconstructing three-dimensional (3D) models from two-dimensional (2D) images is necessary for preoperative planning and the customization of joint prostheses. However, the traditional statistical modeling reconstruction shows a low accuracy due to limited 3D characteristics and information loss. In this study, we proposed a new method to reconstruct the 3D models of femoral images by combining a statistical shape model with Laplacian surface deformation, which greatly improved the accuracy of the reconstruction. In this method, a Laplace operator was introduced to represent the 3D model derived from the statistical shape model. By coordinate transformations in the Laplacian system, novel skeletal features were established and the model was accurately aligned with its 2D image. Finally, 50 femoral models were utilized to verify the effectiveness of this method. The results indicated that the precision of the method was improved by 16.8%–25.9% compared with the traditional statistical shape model reconstruction. Therefore, the method we proposed allows a more accurate 3D bone reconstruction, which facilitates the development of personalized prosthesis design, precise positioning, and quick biomechanical analysis.
【Abstract】 Objective To evaluate the feasibility and effectiveness of reconstruction of mandibular bone defects using three-dimensional skull model and individualized titanium prosthetics from computer assisted design. Methods Between July 2002 and November 2009, 9 patients with mandibular defects accepted restorative operation using individualized bone prosthetics. Among 9 cases, 4 were male and 5 were female, aged 19-55 years. The causes of mandibulectomy were benign lesions in 8 patients and carcinoma of gingival in 1 patient. Mandibular defects exceeded midline in 2 cases, involved condylar in 4 cases, and was limited in one side without involvement of temporo-mandibular joint in 3 cases. The range of bone defects was 9.0 cm × 2.5 cm-17.0 cm × 2.5 cm. The preoperative spiral CT scan was performed and three-diamensional skull model was obtained. Titanium prosthetics of mandibular defects were designed and fabricated through multi-step procedure of reverse engineering and rapid prototyping. Titanium prosthetics were used for one-stage repair of mandibular bone defects, then two-stage implant denture was performed after 6 months. Results The individualized titanium prosthetics were inserted smoothly with one-stage operative time of 10-23 minutes. All the cases achieved incision healing by first intention and the oblique mandibular movement was corrected. They all got satisfactory face, had satisfactory contour and good occlusion. In two-stage operation, no loosening of the implants was observed and the abutments were in good position with corresponding teeth which were designed ideally before operation. All cases got satisfactory results after 1-9 years of follow-up. At last follow-up, X-ray examinations showed no loosening of implants with symmetry contour. Conclusion Computer assisted design and three-dimensional skull model techniques could accomplish the design and manufacture of individualized prosthetic for the repair of mandibular bone defects.
ObjectiveTo summarize the research progress of several three-dimensional (3-D) printing scaffold materials in bone tissue engineering. MethodThe recent domestic and international articles about 3-D printing scaffold materials were reviewed and summarized. ResultsCompared with conventional manufacturing methods, 3-D printing has distinctive advantages, such as enhancing the controllability of the structure and increasing the productivity. In addition to the traditional metal and ceramic scaffolds, 3-D printing scaffolds carrying seeding cells and tissue factors as well as scaffolds filling particular drugs for special need have been paid more and more attention. ConclusionsThe development of 3-D printing porous scaffolds have revealed new perspectives in bone repairing. But it is still at the initial stage, more basic and clinical researches are still needed.
ObjectiveTo evaluate the clinical significance of individualized reference model of sagittal curves by three-dimensional (3D) printing technique and computer-aided navigation system for lumbar spondylolisthesis. MethodsBetween February 2011 and October 2012, 66 patients with lumbar spondylolisthesis underwent posterior lumbar interbody fusion (PLIF) by traditional operation in 36 cases (control group) and by individualized reference model of sagittal curves by 3D printing technique and computer-aided navigation system in 30 cases (trial group). There was no significant difference in gender, age, disease duration, segment, type of disease, degree of spondylolisthesis, and preoperative the visual analogue scale (VAS) of low back pain and leg pain between 2 groups (P>0.05). The operation time, blood loss, fluoroscopy times, VAS score of low back pain and leg pain were compared between 2 groups; the sagittal screw angle (SSA), accuracy rate of pedicle screw, Taillard index, disc height recovery rate, and sagittal angle recovery rate were compared between 2 groups. ResultsThere was no significant difference in operation time and blood loss between 2 groups (P>0.05). But fluoroscopy times of control group were significantly higher than those of trial group (P<0.05). One case had radicular symptoms after operation in control group. The patients of 2 groups were followed up 24-36 months (mean, 26 months). The VAS scores of low back pain and leg pain at last follow-up were significantly better than pre-operative scores in 2 groups (P<0.05); VAS score of low back pain in trial group at last follow-up was significantly lower than that in control group (P<0.05). The accuracy rate of pedicle screw was 81.9% (118/144) in control group and 91.7% (110/120) in trial group, showing significant difference (χ2=5.25, P=0.03). There was significant difference in SSA between 2 groups at immediate after operation (t=-6.21, P=0.00). At immediate after operation and last follow-up, Taillard index, disc height recovery rate, and sagittal angle recovery rate in trial group were significantly better than those in control group (P<0.05). ConclusionPLIF by individualized reference model of sagittal curves by 3D printing technique and computer-aided navigation system can effectively correct spondylolisthesis, recover the lumbar sagittal angle and improve the VAS score of low back pain though it has similar operation time and blood loss to traditional PLIF.
ObjectiveIn this study, three-dimensional printed (3DP) titanium implants were used for skeletal reconstructions after wide excision of chest wall. 3DP titanium implants were expected to provide a valid option with perfect anatomic fitting and personalized design in chest wall reconstruction.MethodsThere were 13 patients [mean age of 46 (24-78) years with 9 males and 4 females] who underwent adequate radical wide excision for tumors and chest wall reconstruction using 3DP titanium implants. Surgical data including patient demographic characteristics, perioperative clinical data and data from 1-year follow-up were collected and analyzed.ResultsSix patients of rib tumors, six patients of sternal tumors and one patient of sternal pyogenic osteomyelitis were finally selected for the study. The chest wall defect area was 221.0±206.0 cm2. All patients were able to maintain the integrity of the chest wall after surgery, and no abnormal breathing was found, achieving personalized and anatomical repair. Thirteen patients were successfully discharged from the hospital. Two patients developed pneumonia in the perioperative period. During the follow-up period in the first year after surgery, no implant related adverse reaction was observed, including implant rupture, implant shift, rejection reaction and allergies. One patient had wound ulcer after chemotherapy. Three patients had tumor recurrence, with the recurrence rate of 25.0%. Two patients died of tumor recurrence, with a mortality rate of 16.7%.Conclusion3DP titanium implant is a safe and effective material for chest wall reconstruction.
Objective To summarize the application progress of three-dimensional (3D) printed metal prosthesis in joint surgery. Methods The related literature was extensively reviewed. The effectiveness of 3D printed metal prosthesis in treatment of joint surgery diseases were discussed and summarized, including the all key issues in prosthesis transplantation such as prosthesis stability, postoperative complications, bone ingrowth, etc. Results 3D printed metal prosthesis has good matching degree, can accurately reconstruct and restore joint function, reduce operation time, and achieve high patient satisfaction in short- and medium-term follow-up. Its application in joint surgery has made good progress. Conclusion The personalized microporous structure prostheses of different shapes produced by 3D printing can solve the problem of poor personalized matching of joints for special patients existing in traditional prostheses. Therefore, 3D printing technology is full of hope and will bring great potential to the reform of orthopedic practice in the future.
ObjectiveTo analyze intrahepatic vascular structures, divide liver segment automatically, and carry out virtual anatomic hepatectomy for virtual liver surgery planning based on liver threedimensional images. MethodsThe branches of portal vein were labeled in the level of segment based on spiral CT scanning images by using the liver surgery planning system software Liv 1.0. Thus, the simulation of an anatomical resection could be carried out. ResultsAccording to the portal segment branches, each individual liver segment could be divided automatically. The three-dimensional liver model was reconstructed based on liver segments, and the margin of liver segments was displayed clearly. On that basis, the simulation of anatomical resection and the volumetric estimation could be performed. ConclusionsThe three-dimensional liver model with intrahepatic vessel is reconstructed clearly, automatic segmentation of liver segment, the simulation of anatomical resection, and volumetric estimation can be applied in succession. The planning can be accomplished with Liv 1.0 on personal computer by the user, which provides a software platform for clinical application of virtual liver techniques.