Application of Three-Dimensional Printing in Craniofacial Surgery--A Single Institution's 6-Year Experience

3D列印於顱顏手術中之應用及模型製作現況－單一中心之6年經驗

王思翰(Szu-Han Wang) ； 姚全豐(Chuan-Fong Yao) ； 周邦昀(Pang-Yun Chou) ； 林秀霞(Hsiu-Hsia Lin) ； 廖郁芳(Yu-Fang Liao) ； 陳潤茺(Zung-Chung Chen) ； 羅綸洲(Lun-Jou Lo)

《臺灣整形外科醫學會雜誌》 31卷2期 (2022/06) Pp. 84-94

摘要

Background: Three-dimensional (3D) printing has been applied in numerous fields of medicine such as orthopedic surgery, maxillofacial surgery, cranial surgery, trauma surgery, spinal surgery, and even tissue engineering to improve surgical outcomes. However, few studies have analyzed the time of manufacturing and cost of material consumption and malfunction repair. Moreover, the selection of an appropriate 3D printer and materials is essential. Aim and Objectives: This retrospective study analyzed 3D printing application in a single institution in terms of usage, time, material consumption, and cost of manufacturing. The selection of 3D printer and materials and trends in 3D-printing manufacturing were also evaluated. Materials and Methods: All the information and records on the usage condition of 3D printing machines in Taoyuan Chang Gung Craniofacial Center from December 2014 to January 2021 were collected. The purpose of manufacturing was divided into maxillofacial surgery stents/splints, ear models, and others. We also collected data including machine type and cost, material amount and cost, manufacturing time, number of models, type of surgeons, and malfunction issues. The application of models, manufacturing time, material consumption, and manufacturing cost were considered primary outcomes. Results: From December 2014 to January 4, 2021, 5168 models were manufactured. An increase in 3D-printed model production in the last 6 years was noted. Almost 70% of production was for intraoperative maxillofacial stents/splints (n = 3611, 69.9%), followed by ear models (24.1%). The average production of intraoperative maxillofacial stents/splints was 601.8 pieces per year, that for ear models was 208 pieces per year, and that for others was 51.5 pieces per year. The average cost of intraoperative maxillofacial stents/splints and ear models was US$16.7 and US$24.6, respectively, and the average printing time was 2 h and 41 min per object. Orthodontists were involved in 63% of the models. The most frequent major malfunction was damage to the ultraviolet light, and the main minor malfunction was hardware adjustment and associated problems. Conclusion: Our data indicated an increasing trend in 3D printing at our craniofacial center over the past 6 years. 3D-printed models are useful in different aspects of clinical practice, such as preoperative simulation, intraoperative guidance, preoperative explanation, and postoperative patient education. Various 3D printer parameters, such as frequency of malfunction and printing layer accuracy, should be considered before use. Material selection was also critical, and we selected transparent biocompatible modeling material to create our intraoperative maxillofacial stents/splints and ear models.

關鍵字

3D printing ； cost ； maxillofacial surgery ； microtia

並列摘要

背景：三維立體（3D）列印技術如今已應用於骨科手術、顱顏外科手術、外傷手術、脊椎手術甚至組織工程等諸多領域，許多不同次專科的醫師亦已應用此技術於臨床上，並期待改善手術成果。然而，3D列印模型製造的時間、材料消耗以及故障修復的成本分析研究較少，且相關的3D列印機器及材料的選擇也應該在3D列印中心設置時一併考慮。目的及目標：因此我們設計了一個回顧性研究以分析單一機構的三維立體（3D）列印模型生產及應用，並將使用情況、時間和材料消耗以及製造成本進行統合性的整理，也以桃園長庚醫院顱顏中心的3D列印生產及應用經驗進行趨勢分析，期望可以給予後續有設立3D列印中心需求的單位一些具有建設性的參考。材料及方法：此研究收集了桃園長庚顱顏中心由2014年12月至2021年1月所有3D列印機的使用情況紀錄，並將其3D列印的目的分為顱顏外科咬合板／支架、耳部重建模型等，此外，我們亦收集了相關的統計數據，包含機器類型和價格、材料使用的數量和價格、製造時間消耗、模型數量、使用醫生的科別以及故障和維修的記錄，並以3D列印機的使用狀況、時間和材料的消耗以及製造成本為主要研究結果。結果：自2014年12月至2021年1月4日，桃園長庚醫院顱顏中心共生產模型5168個，且近6年3D列印的模型生產量有明顯增加的趨勢，近70%的列印模型是顱顏外科術中咬合板／支架（n=3611, 69.9%），而其平均產量為每年601.8個，耳模型則占所有模型的24.1%，其平均產量為208個／年，其他相關模型則為51.5個／年，另一方面而言，顱顏外科術中咬合板／支架以及耳部重建模型的平均成本分別為美金16.7元（新台幣468元）和美金24.6元（新台幣687元），且單一物件的平均列印時間為2小時41分鐘，矯正牙科醫師佔3D列印模型設計及製造的63%。紫外光（UV light）部件損壞是最常見的主要故障，而硬體校正及相關問題則是次要故障的主要原因。結論：根據我們的研究，近6年來，我們的顱顏中心使用3D列印模型的趨勢有明顯增加，且3D列印模型可有助於臨床工作的不同面向，例如術前模擬、術中的參考、術前解釋以及術後患者衛教等，然而3D列印機器的設置亦有很多須注意的部分，例如故障頻率和列印積層的精準度等，因此實際設置及操作生產前應先進行全面的考量，根據不同的臨床需求來選擇不同的列印材料也十分重要，我們也因而選擇具有生物相容性且透明的材質作為我們顱顏外科術中咬合板／支架以及耳部重建模型的主要材料。