3D列印於骨腫瘤手術之應用

近年來發展蓬勃的3D列印是一種「增材製造（additive manufacturing）」技術，克服了過去減材製造（substractive manufacturing）」的限制，能夠製造出各種型態的物品。骨腫瘤手術常面臨切除邊界不易掌控以及巨大骨缺損如何重建的難題。由於目前不易取得合適形狀之異體骨或人工假體，而現有之固定物有時無法達到在個別案例上得到形狀服貼及穩定固定的效果，手術往往耗時費工，且併發症之風險也較高，造成病患有時功能上無法完全恢復。隨著3D製造技術的導入，目前已可用病患自身的腫瘤及骨骼為模板製作出腫瘤模型、切骨導具、及吻合病患腫瘤切除後骨缺損的假體，可幫助醫師進行術前計畫，解說病情和手術過程，精準重現計畫之切骨位置，及植入符合病患解剖構造的客製化假體。假以時日，隨著組織工程材料學的進展，假體與周邊自體骨的融合率可望提升，將可提供病患立即可用且長期穩固的高功能重建。

關鍵字

3D列印； 3D導引切骨； 3D列印假體；骨腫瘤；骨骼肉瘤

並列摘要

The recent surge of 3D printing technology has revolutionized the manufacturing industry, as the ＂additive＂ instead of ＂substractive＂ nature of this process allows for the creation of objects of virtually any shape and geometry. Introduction of 3D printing into the manufacturing process of medical implants holds great potential for bone tumor surgery, wherein optimal resection margins are difficult to obtain and massive bone defects pose significant challenge for reconstruction. Currently an allograft or prosthesis that perfectly matches the patient's native anatomy after tumor resection is hard to come by. Therefore, surgeons often encounter difficulties in achieving an anatomically-fit, immediately-stable construct that is also highly functional and durable in the long run. 3D printing technology has been utilized in creating 3D tumor models, patient-specific resection guides, and anatomically-shaped prostheses tailored to individual patient's unique needs. These applications have made it easier for surgeons to provide pre-operative counseling, formulate surgical plan, carry out planned resection and achieve individualized reconstruction. It is hoped that advances in bone tissue engineering and in material science will complement 3D-printed instrument and implants in the future so that surgeons can perform reconstructions that are immediately stable, instantly ready to use, and well-integrated with the host bone overtime.

並列關鍵字

3D printing ； 3D guided resection ； 3D-printed prosthesis ； bone tumor ； bone sarcoma

參考文獻

Matsumoto JS, Morris JM, Rose PS: 3-dimensional printed anatomic models as planning aids in complex oncology surgery. JAMA Oncol 2016;2:1121-2. doi: 10.1001/jamaoncol.2016.2469

Cartiaux O, Docquier PL, Paul L, et al: Surgical inaccuracy of tumor resection and reconstruction within the pelvis: An experimental study. Acta Orthop 2008;79:695-702. doi: 10.1080/17453670810016731

Sallent A, Vicente M, Reverte MM, et al: How 3D patient-specific instruments improve accuracy of pelvic bone tumour resection in a cadaveric study. Bone Joint Res 2017;6:577-83. doi: 10.1302/2046-3758.610.BJR-2017-0094.R1

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3D列印於骨腫瘤手術之應用

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