3D printing helps doctors improve the accuracy of implanted acetabular prosthesis
[ China Pharmaceutical Network Technology News ] High-tech 3D printing + reconstruction technology can easily solve the problem of low precision of orthopedic experts manually implanted acetabular prosthesis. This "assisting artifact" looks like two horseshoe-shaped magnet stones, scientific name It is called “artificial acetabular cup implant guideâ€. Before total hip arthroplasty embodiment, first 1: 1 ratio hip model print out, and then a suitable model for railways according to the guide strip, is made by 3D printing.
Rework acetabular prosthesis
These two iron-shaped objects less than 10 cm in length represent the current leading level of 3D printing in orthopedic clinical medicine, and this idea has only experienced more than half a year from idea to success. "After hip replacement, revision prosthesis reasons are many, but there is one very important reason is that at the time of replacement, the acetabular cup installation could not be precise, leading to wear and tear or come off." Zhouguan Ming holding a model of the hip joint acetabular prosthesis model and gestures. "For example, on this point, tilt it, when the patient action, it will move slowly it will wear." Zhouguan Ming explained that position long years, acetabulum in patients with total hip arthroplasty has lesions or incomplete.
"In patients with lesions, the acetabulum may have been irregular, so the acetabular cup prosthesis should be accurately placed in the acetabulum, and the accuracy of manual implantation will be biased." Zhou Guanming said frankly, plus around the hip. Soft tissue (muscle and fat) blocks sight, and even an experienced orthopaedic surgeon cannot guarantee 100% accuracy when placed in an acetabular prosthesis. "Even as I am engaged in artificial hip replacement, for many years, we can not guarantee one hundred percent accurate." Once in the inaccurate, it will lead to the acetabular component wear or fall off, thus affecting the function of the patient, "is bound to be renovated." This problem has plagued many orthopaedic surgeons, including well-known orthopedic experts and Professor Liu Xiaoyi, dean of Foshan Traditional Chinese Medicine Hospital. For Foshan Traditional Chinese Medicine Hospital, the total hip arthroplasty has reached 2,000 units a year, and the number of operations is among the highest in the country.
Looking for precision aids
“There is no tool to assist the doctor in completing the operation, so that the angle of the acetabular cup prosthesis can be accurately adjusted to avoid the resulting renovation.†This is the subject that Liu Xiaofang has been thinking about. At present, the internationally recognized cupping prosthesis is placed at an angle of 40 +/- 10° and a anteversion angle of 15 +/- 5°. This is called the “Lew innek cup safe zoneâ€. "In general, if the angle of implantation of the cup prosthesis is not in the safe zone, it can be considered that the poor angle of implantation of the cup prosthesis will affect the range of motion of the hip joint and the service life of the prosthesis, and change the stress between the interfaces of the prosthesis. ."
The idea of ​​Liu Xiaofang is precisely the problem that can be solved by the products being studied by Dr. DrGek Lim of Silicon Valley. Dr. Dr. GekLim specializes in digital imaging and is engaged in the development and research of orthopedic instruments in the United States. He was a postdoctoral fellow at Bell Labs. She carries a large black backpack all year round, carrying a black box with a hip model and an acetabular guide. This looks like a horseshoe-shaped magnetite, which can easily solve the troubled Liu. Imitate, Zhou Guanming and other orthopedic experts. A key step in total hip arthroplasty—the acetabular component can be implanted at the desired angle, minimizing the possible wear and tear and prolonging the life of the prosthesis.
Zhou Guanming (left), director of the joint specialist of Foshan Traditional Chinese Medicine Hospital, demonstrated the 3D printed “artificial acetabular cup implant guideâ€.
The prototype is "too closed door to build a car"
Every new application and research is born out of the dedication of a person or a group. The same is true for this guide. DrGek Lim talked about the birth of the acetabular implant guide, and repeatedly thanked Liu for copying the "Bole". In 2015, DrGekLim began to develop 3D digital reconstruction software. For this software, Liu Xiaofang, a top expert in orthopedics, gave many opinions and suggestions, which is precisely the basis for the later 3D printing acetabular implant guides. DrGekLim, who travels all over the world all year round, knows the world's orthopaedic surgical tools and instruments. "Before foreign people have developed two guides, which are used to polish the acetabulum and implant the prosthesis, but the two are separate, the doctor needs to use twice, the use is inconvenient; some guides need to be modified Equipment, it is difficult to promote.†After DrG ekLim learned from these experiences, in March 2016, the ideas and plans were formed and patents were applied. "But after all, this is only a technical level. If you want to use it clinically, you should show it to the clinical doctors." DrG ek Lim thought of the Foshan Traditional Chinese Hospital led by Liu Xiaofang.
One day in May 2016, she took a photo of the design and found Liu Xiangfang. “At the time, he said that this design is very good, so that we can make it first.†However, design research to successful application requires a process of continuous improvement. The time progressed to June 2016, a phone call by Liu Biao, speeding up the application of 3D printing acetabular prosthesis implant guides. “Liu Yuan called me and said, let me make a set of guides first, I want to use it in the operation. If it is successful, it will be explained as a case at the August International Conference of Orthopaedics.†Dr GekLim answered the call as if The chicken blood, after receiving the image data of the patient who had undergone hip replacement surgery in the hospital from the Chinese hospital, including CT scan and X-ray film, immediately began to use 3D digital modeling.
“After modeling, the hip joint model should be printed in a 1:1 ratio, then the appropriate guides should be designed according to the model, and then printed by a 3D printer.†Each hip joint model is personalized and different. The shape and design of the guide are also unique. This strip of approximately 10 cm long horseshoe-shaped magnets and another similar semi-circular strip is the guide. "Looking at the simplicity, the design is still very difficult. The vertical guides should not be too long, and they should not be too short. They should not be put too long. If they are too short, they will be blocked by the muscles." The horizontal guide should be free from the patient's hip joint. The seams are butt joints, and they must not be convex or concave at the same level. The strength is just right. "The length of the transverse guide should not exceed half of the acetabular cup. For example, the diameter of the acetabular prosthesis is 4cm, and the transverse guide cannot exceed 2cm. Too long will block the doctor's surgery."
DrGekLim, who specializes in technical products, does not have much experience in orthopedics. The first time, Liu Yifang pointed out the shortcomings. "The first horizontal guide, we designed the round, Liu Yiyi said, this can not be used clinically, the designer is too closed to build a car." Liu Xiaofang suggested that the guide should be shorter, can not hinder the doctor's surgery But it can't be too short to be blocked by muscle barriers. DrGekLim improved the length of the guide according to Liu's suggestion. The second set of guides was approved by Liu Yifang, and Liu proposed further modifications.
Customized "guides" for 48 hours
After two rounds of running-in, a surgery in July 2016 provided an excellent practice test. Liu Xiaoyi felt that the time was ripe and decided to apply the director to do it. “The time given by Director Zhou Guanming is very tight. Because of the many operations, I have to make a personalized guide within 48 hours and send it to the hospital for disinfection.†After DrGekLim took the patient's image map of the hospital, at 48 The modeling, the design of the guide, the 3D printing guide and the model were completed within an hour, and then sent to Foshan City Hospital for disinfection.
In the end, Liu Xiaofang and Zhou Guanming performed the first total hip arthroplasty using a 3D printed personalized artificial acetabular cup implant guide. The operation was smooth and successful. In August, Liu Xiaofang shared this new technology at the National Orthopaedic International Conference. In November, Zhou Guanming also shared this new technology at the COA International Conference. Up to now, Foshan Traditional Chinese Medicine has successfully implemented 4 cases of total hip arthroplasty through the guiding cup, all of which achieve high precision.
Li Xiaomi, 24, is one of the four beneficiaries of this new technology. She had previously affected her normal walking because of bilateral hip pain. She received “bilateral total hip arthroplasty†at Foshan Traditional Chinese Medicine Hospital at the end of last year. It is now possible to abandon and walk normally. The results of the operation showed that the artificial acetabular abduction angle implanted in her body was 41° to the right hip and 39.8° to the left hip, which was less than 2° from the preoperative planned 40°, achieving highly accurate implantation. "With this guide implant, it is possible to avoid the possibility of acetabular prosthesis shedding or wear due to inaccurate implant accuracy and reduce the chance of revision." Zhou Guanming said.
For DrGek Lim, the success of the guide is not only a career success, but it makes sense for her to use high technology to help doctors see the doctor. “Next, we plan to conduct 100 clinical trials, collect data, and make a database to see what can be found.†DrGekLim is currently registered in Foshan, a company responsible for 3D printing of acetabular prosthesis implant guides. business. For Foshan Traditional Chinese Medicine Hospital, the success of 3D printing guides also provided them with more inspiration and ideas. Liu Xiaofang and his team are considering how to apply this high technology to other operations in orthopedics.
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