More and more relevant research results show that anatomical segmentectomy has the same effect as traditional lobectomy in the surgical treatment of early-stage non-small cell lung cancer (diameter<2.0 cm). Segmentectomy is more difficult than lobotomy. Nowadays, with the promotion of personalization medicine and precision medicine, three-dimensional technique has been widely applied in the medical field. It has advantages such as preoperative simulation, intraoperative positioning, intraoperative navigation, clinical teaching and so on. It plays a key role in the discovery of local anatomical variation of pulmonary segment. This paper reviewed the clinical application of three-dimensional technique and briefly described the clinical application value of this technique in segmentectomy.
ObjectiveTo explore the application value of multidisciplinary collaborative team (MDT) model in retroperitoneal tumors involving large vessels.MethodsThree cases of retroperitoneal tumors involving great vessels admitted to Xiang’an Hospital of Xiamen University in 2019 were retrospectively analyzed. With the support of 3D visual reconstruction and virtual reality (VR) technology, we performed MDT discussion and three cases received treatment of surgery, intervention, and targeted therapy.ResultsCase 1 was discussed by MDT and concluded that, based on CT examination, 3D reconstruction, and VR virtual image results, the tumor on the right side was determined to be completely resectable. The left tumor was judged to be unresectable, and the proposed treatment plan was right metastatic tumor resection + left metastatic tumor radiofrequency ablation. After surgery case 1 had been followed up for 6 months. The symptoms of diarrhea were significantly improved. CT reexamination showed that liver lesions and left retroperitoneal lesions were the same size and the condition was stable. After discussion by MDT, radiofrequency ablation around the tumor was proposed for case 2. This case was followed up for 3 months after surgery, and CT reexamination showed no new lesion in retroperitoneum. After MDT discussion, we concluded that arteriovenous fistula of case 3 had no indications for surgery, and proposed interventional combined with targeted therapy. After treatment, the tumor was found to be smaller after reexamination in 8 months than before treatment, and the efficacy was evaluated as partial remission. The follow-up was continued.ConclusionThe future development trend of retroperitoneal tumor therapy involving great vessels is to evaluate each patient’s condition under the MDT mode by using 3D visual reconstruction and VR technology, and to formulate the individualized treatment plan of operation combined with other treatments.
Objective To design a new type of three-dimensional honeycomb guide for percutaneous cannulated screw placement in femoral neck fracture and evaluate its effectiveness. Methods The clinical data of 40 patients with femoral neck fracture who met the selection criteria between June 2019 and December 2020 were retrospectively analyzed. According to different intraoperative positioning methods, they were divided into control group (20 cases, free hand positioning screws) and study group (20 cases, new guide assisted positioning screws). There was no significant difference in gender, age, side, cause of injury, Garden classification, and time from injury to operation between the two groups (P>0.05). The operation time, fluoroscopy times, guide needle puncture times, and fracture healing time of the two groups were recorded. The hip function was evaluated by Harris score at last follow-up. At immediate after operation, the following imaging indexes were used to evaluate the accuracy of screw implantation distribution: screw spacing, screw coverage area, distance from screw to cervical cortex, parallelism between screws, and screw to cervical axial deviation. Results All operations were successfully completed, and the guide needle did not penetrate the femoral neck cortex. There was no significant difference in operation time and fluoroscopy times between the two groups (P>0.05); the guide needle puncture times in the study group was significantly less than that in the control group (t=8.209, P=0.000). Imaging detection at immediate after operation showed that the screw spacing and screw coverage area in the study group were significantly greater than those in the control group (P<0.05); the distance from screw to cervical cortex, parallelism between screws, and screw to cervical axial deviation were significantly smaller than those in the control group (P<0.05). All patients were followed up 7-25 months, with an average of 19.3 months. There was no significant difference in follow-up time between the two groups (t=−0.349, P=0.729). There were 2 cases of fracture nonunion in the control group and 1 case in the study group, and the other fractures completely healed. One case of osteonecrosis of the femoral head occurred in the control group. During the follow-up, there was no complication such as vascular and nerve injury, venous thrombosis, screw penetration, withdrawal, breakage, and refracture, etc. There was no significant difference in fracture healing time and Harris score at last follow-up between the two groups (P>0.05). ConclusionThe new three-dimensional honeycomb guide has the advantages of simple structure and convenient use. It can reduce the puncture times of the guide needle and effectively improve the accuracy distribution of cannulated screw implantation.
ObjectiveTo explore the effectiveness of a new point contact pedicle navigation template (referred to as “new navigation template” for simplicity) in assisting screw implantation in scoliosis correction surgery. MethodsTwenty-five patients with scoliosis, who met the selection criteria between February 2020 and February 2023, were selected as the trial group. During the scoliosis correction surgery, the three-dimensional printed new navigation template was used to assist in screw implantation. Fifty patients who had undergone screw implantation with traditional free-hand implantation technique between February 2019 and February 2023 were matched according to the inclusion and exclusion criteria as the control group. There was no significant difference between the two groups (P>0.05) in terms of gender, age, disease duration, Cobb angle on the coronal plane of the main curve, Cobb angle at the Bending position of the main curve, the position of the apical vertebrae of the main curve, and the number of vertebrae with the pedicle diameter lower than 50%/75% of the national average, and the number of patients whose apical vertebrae rotation exceeded 40°. The number of fused vertebrae, the number of pedicle screws, the time of pedicle screw implantation, implant bleeding, fluoroscopy frequency, and manual diversion frequency were compared between the two groups. The occurrence of implant complications was observed. Based on the X-ray films at 2 weeks after operation, the pedicle screw grading was recorded, the accuracy of the implant and the main curvature correction rate were calculated. ResultsBoth groups successfully completed the surgeries. Among them, the trial group implanted 267 screws and fused 177 vertebrae; the control group implanted 523 screws and fused 358 vertebrae. There was no significant difference between the two groups (P>0.05) in terms of the number of fused vertebrae, the number of pedicle screws, the pedicle screw grading and accuracy, and the main curvature correction rate. However, the time of pedicle screw implantation, implant bleeding, fluoroscopy frequency, and manual diversion frequency were significantly lower in trial group than in control group (P<0.05). There was no complications related to screws implantation during or after operation in the two groups. ConclusionThe new navigation template is suitable for all kinds of deformed vertebral lamina and articular process, which not only improves the accuracy of screw implantation, but also reduces the difficulty of operation, shortens the operation time, and reduces intraoperative bleeding.
ObjectiveTo investigate the effectiveness of percutaneous double-segment lengthened sacroiliac screws internal fixation assisted by three-dimensional (3D) navigation technology in treatment of Denis type Ⅱ and Ⅲ sacral fractures. Methods A clinical data of 45 patients with the Denis type Ⅱ and Ⅲ sacral fractures admitted between January 2017 and May 2020 was retrospectively analyzed. There were 31 males and 14 females, with an average age of 48.3 years (range, 30-65 years). The pelvic fractures were all high energy injuries. According to the Tile classification standard, there were 24 cases of type C1, 16 cases of type C2, and 5 cases of type C3. The sacral fractures were classified as Denis type Ⅱ in 31 cases and type Ⅲ in 14 cases. The interval between injury and operation was 5-12 days (mean, 7.5 days). The lengthened sacroiliac screws were implanted in S1 and S2 segments respectively under the assistance of 3D navigation technology. The implantation time of each screw, the intraoperative X-ray exposure time, and the occurrence of surgical complications were recorded. After operation, the imaging reexamination was used to evaluate the screw position according to Gras standard and the reduction quality of sacral fractures according to Matta standard. At last follow-up, the pelvic function was scored with Majeed scoring standard. Results The 101 lengthened sacroiliac screws were implanted with the assisting of 3D navigation technology. The implantation time of each screw was 37.3 minutes on average (range, 30-45 minutes), and the X-ray exposure time was 46.2 seconds on average (range, 40-55 seconds). All patients had no neurovascular or organ injury. All incisions healed by first intention. The quality of fracture reduction was evaluated according to Matta standard as excellent in 22 cases, good in 18 cases, and fair in 5 cases, and the excellent and good rate was 88.89%. The screw position was evaluated according to Gras standard as excellent in 77 screws, good in 22 screws, and poor in 2 screws, and the excellent and good rate was 98.02%. All patients were followed up 12-24 months (mean, 14.6 months). All fractures healed and the healing time was 12-16 weeks (mean, 13.5 weeks). Pelvic function was evaluated according to Majeed scoring standard as excellent in 27 cases, good in 16 cases, fair in 2 cases, and the excellent and good rate was 95.56%. Conclusion Percutaneous double-segment lengthened sacroiliac screws internal fixation for the treatment of Denis type Ⅱ and Ⅲ sacral fractures is minimally invasive and effective. With the assistance of 3D navigation technology, the screw implantation is accurate and safe.
Three-dimensional (3D) printing is a low-cost, high-efficiency production method, which can reduce the current cost and increase the profitability of skin repair material industry nowadays, and develop products with better performance. The 3D printing technology commonly used in the preparation of skin repair materials includes fused deposition molding technology and 3D bioprinting technology. Fused deposition molding technology has the advantages of simple and light equipment, but insufficient material selection. 3D bioprinting technology has more materials to choose from, but the equipment is cumbersome and expensive. In recent years, research on both technologies has focused on the development and application of materials. This article details the principles of fused deposition modeling and 3D bioprinting, research advances in wound dressings and tissue engineering skin production, and future developments in 3D printing on skin tissue repair, including cosmetic restoration and biomimetic tissue engineering. Also, this review prospects the development of 3D printing technology in skin tissue repairment.
ObjectiveTo investigate the correlation between glenohumeral joint congruence and stability in recurrent shoulder dislocations. Methods Eighty-nine patients (89 sides) with recurrent shoulder dislocation admitted between June 2022 and June 2023 and met the selection criteria were included as study subjects. There were 36 males and 53 females with an average age of 44 years (range, 20-79 years). There were 40 cases of left shoulder and 49 cases of right shoulder. The shoulder joints dislocated 2-6 times, with an average of 3 times. The three-dimensional models of the humeral head and scapular glenoid were reconstructed using Mimics 20.0 software based on CT scanning images. The glenoid track (GT), inclusion index, chimerism index, fit index, and Hill-Sachs interval (HSI) were measured, and the degree of on/off track was judged (K value, the difference between HSI and GT). Multiple linear regression was used to analyze the correlation between the degree of on/off track (K value) and inclusion index, chimerism index, and fit index. ResultsMultiple linear regression analysis showed that the K value had no correlation with the inclusion index (P>0.05), and was positively correlated with the chimerism index and the fit index (P<0.05). Regression equation was K=–24.898+35.982×inclusion index+8.280×fit index, R2=0.084. ConclusionHumeral head and scapular glenoid bony area and curvature are associated with shoulder joint stability in recurrent shoulder dislocations. Increased humeral head bony area, decreased scapular glenoid bony area, increased humeral head curvature, and decreased scapular glenoid curvature are risk factors for glenohumeral joint stability.
Objective To evaluated the application effect of reverse digital modeling combined with three-dimensional (3D)-printed disease models in the standardized training of orthopedic residents focusing on pelvic tumors. Methods From August 2022 to August 2023, 60 orthopedic residents from West China Hospital, Sichuan University were randomly assigned to a trial group (n=30) and a control group (n=30). The trial group received instruction using reverse digital modeling and 3D-printed pelvic tumor models, while the control group underwent traditional teaching methods. Teaching outcomes were evaluated and compared between groups through knowledge tests, practical skill assessments, and satisfaction surveys. Results Before training, there was no statistically significant difference in knowledge tests or practical skill assessments between the two groups (P>0.05). After training, the trial group showed significantly better performance than the control group in knowledge tests (90.5±5.2 vs. 78.4±6.8, P<0.05), skill assessments (92.7±4.9 vs. 81.3±6.2, P<0.05), and satisfaction surveys (9.40±1.10 vs. 7.60±1.20, P<0.05). One month after training, the trial group still showed significantly better performance than the control group in knowledge tests (88.1±6.4 vs. 72.3±7.1, P<0.05) and skill assessments (90.3±5.8 vs. 75.6±6.9, P<0.05). Conclusions Reverse digital modeling combined with 3D printing offers an intuitive and effective teaching approach that improves comprehension of pelvic tumor anatomy and strengthens clinical and technical competencies. This method significantly enhances learning outcomes in standardized residency training and holds promise for broader integration into medical education.
Objective To investigate the accuracy of split three-dimensional (3D) printing patient-specific instrumentation (PSI) in medial open-wedge high tibial osteotomy (MOWHTO) and its effectiveness in treating medial knee osteoarthritis.MethodsClinical data of 14 patients with medial knee osteoarthritis and treated with split 3D printing PSI-assisted MOWHTO between August 2019 and August 2020 were retrospectively analyzed. There were 5 males and 9 females with an average age of 61 years (range, 43-68 years). The disease duration ranged from 1 to 16 years, with an average of 4.7 years. Preoperative Kellgren-Lawrence grading of knee osteoarthritis included grade Ⅰ in 2 cases, grade Ⅱ in 6 cases, and grade Ⅲ in 6 cases. The Hospital for Special Surgery (HSS) score was 59.1±4.9. The weight bearing line ratio (WBL), hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), posterior tibial slope angle (PTSA), and actual correction angle of the lower limbs were measured on postoperative imaging data, and compared with the preoperative measurements and the designed target values to evaluate the accuracy of the PSI-assisted surgery. The patients’ knee function were evaluated with the HSS score at 3 and 6 months postoperatively, and at last follow-up.ResultsOne patient suffered from an incision exudation at 2 weeks postoperatively, and the incision healed after symptomatic treatment. The incisions of other patients healed by first intention. All patients were followed up 7-19 months (mean, 14.8 months). There was no neural injuries, hinge fracture, plate or screw fractures, loosening, or other complications. The WBL was maintained at the postoperative level according to the X-ray examination during the follow-up period. The WBL, HKA, MPTA, and PTSA were all within a satisfactory range after operation. The WBL, HKA, and MPTA were significantly improved when compared with the preoperative measurements (P<0.05). There was no significant difference between preoperative and postoperative PTSA (P>0.05). The differences in postoperative WBL, HKA, MPTA, and correction angle compared with the preoperative designed target values were not significant (P>0.05). The HSS scores were 69.2±4.7, 77.7±4.3, and 88.1±5.4 at 3 and 6 months postoperatively, and last follow-up, respectively. The differences between time points were significant (P<0.05).ConclusionFor patients with medial knee osteoarthritis, the split 3D printing PSI can assist the surgeon in MOWHTO with accurate osteotomy orthopedics and achieve favorable effectiveness.
In this article, we introduce the principle, describe the utilization and discuss the future development of three-dimensional printing technology for manufacturing artificial organs.