Name: three-dimensional printing guide template assisted percutaneous vertebroplasty (pvp)
Uploaded: 2019-10-17T12:30:00
Description: Watch this Scientific Journal Video about Three-Dimensional Printing Guide Template Assisted Percutaneous Vertebroplasty PVP at JoVE.com

该研究由北京市科学技术委员会资助（中国，中国，中国，Z.Z181100001718078）。

本研究得到了北京友谊医院首都医科大学伦理委员会的批准。
1. 通过X射线荧光镜检查、磁共振成像（MRI）、骨丝镜和症状诊断骨质椎骨压缩性骨折（OVCF）
<ol><li>识别老年患者有OVCF的患者，有背痛、脊柱过程中的压痛、背部的中脊髓肌肉等。</li>
	<li>使用后体X射线荧光镜检查患者是否有椎骨压缩性骨折。</li>
	<li>使用 MRI 诊断患者是否有新发病的椎骨压缩性骨折，并确定目?...

<ol>
	<li>Orthopaedic Society of the Chinese Medical Association. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Guidelines+for+the+diagnosis+and+treatment+of+osteoporotic+fractures.">Guidelines for the diagnosis and treatment of osteoporotic fractures.</a> Chinese Journal of Orthopaedics. 37 (1), 1-10 (2017).</li><li>Yi, H. J., Jeong, J. H., Im, S. B., Lee, J. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Percutaneous+vertebroplasty+versus+conservative+treatment+for+one+level+thoracolumbar+osteoporotic+compression+fracture:+Results+of+an+over+2-year+follow-up.">Percutaneous vertebroplasty versus conservative treatment for one level thoracolumbar osteoporotic compression fracture: Results of an over 2-year follow-up.</a> Pain Physician. 19 (5), (2016).</li><li>Balkarli, H., Demirtas, H., Kilic, M., Ozturk, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+of+osteoporotic+vertebral+compression+fractures+with+percutaneous+vertebroplasty+under+local+anesthesia:+clinical+and+radiological+results.">Treatment of osteoporotic vertebral compression fractures with percutaneous vertebroplasty under local anesthesia: clinical and radiological results.</a> International Journal of Clinical &amp; Experimental Medicine. 8 (9), 16287-16293 (2015).</li><li>Woojin, C., Varkey, J. A., Jing, C., Hwan, B. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Review+of+Current+Clinical+Applications+of+Three+Dimensional+Printing+in+Spine+Surgery.">A Review of Current Clinical Applications of Three Dimensional Printing in Spine Surgery.</a> Asian Spine Journal. 12 (1), 171-177 (2018).</li><li>Laredo, J. D., Hamze, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complications+of+percutaneous+vertebroplasty+and+their+prevention.">Complications of percutaneous vertebroplasty and their prevention.</a> Skeletal Radiology. 33 (9), 493-505 (2004).</li><li>Saracen, A., Kotwica, Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complications+of+percutaneous+vertebroplasty:+An+analysis+of+1100+procedures+performed+in+616+patients.">Complications of percutaneous vertebroplasty: An analysis of 1100 procedures performed in 616 patients.</a> Medicine. 95 (24), e3850 (2016).</li><li>Park, H. J., Wang, C., Choi, K. H., Kim, H. N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+a+life-size+three-dimensional-printed+spine+model+for+pedicle+screw+instrumentation+training.">Use of a life-size three-dimensional-printed spine model for pedicle screw instrumentation training.</a> Journal of Orthopaedic Surgery and Research. 13 (1), 86 (2018).</li><li>Gu, Y. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Percutaneous+vertebroplasty+and+interventional+tumor+removal+for+malignant+vertebral+compression+fractures+and/or+spinal+metastatic+tumor+with+epidural+involvement:+a+prospective+pilot+study.">Percutaneous vertebroplasty and interventional tumor removal for malignant vertebral compression fractures and/or spinal metastatic tumor with epidural involvement: a prospective pilot study.</a> Journal of Pain Research. 10, 211-218 (2017).</li><li>Ruiz, S. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparative+review+of+vertebroplasty+and+kyphoplasty.">Comparative review of vertebroplasty and kyphoplasty.</a> World Journal of Radiology. 6 (6), 329-343 (2014).</li><li>Cannavale, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Percutaneous+vertebroplasty+with+the+rotational+fluoroscopy+imaging+technique.">Percutaneous vertebroplasty with the rotational fluoroscopy imaging technique.</a> Skeletal Radiology. 43 (11), 1529-1536 (2014).</li><li>Ringer, A. J., Bhamidipaty, S. V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Percutaneous+access+to+the+vertebral+bodies:+a+video+and+fluoroscopic+overview+of+access+techniques+for+trans-,+extra-,+and+infrapedicular+approaches.">Percutaneous access to the vertebral bodies: a video and fluoroscopic overview of access techniques for trans-, extra-, and infrapedicular approaches.</a> World Neurosurgery. 80 (3-4), 428-435 (2013).</li><li>Kaneyama, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+novel+screw+guiding+method+with+a+screw+guide+template+system+for+posterior+C-2+fixation.">A novel screw guiding method with a screw guide template system for posterior C-2 fixation.</a> Neurosurgery Spine. 21 (2), 231-238 (2014).</li><li>Sugawara, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Multistep+pedicle+screw+insertion+procedure+with+patient-specific+lamina+fit-and-lock+templates+for+the+thoracic+spine.">Multistep pedicle screw insertion procedure with patient-specific lamina fit-and-lock templates for the thoracic spine.</a> Neurosurgery Spine. 19 (2), 185-190 (2013).</li><li>Li, J., Lin, J. S., Yang, Y., Xu, J. C., Fei, Q. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=3-Dimensional+printing+guide+template+assisted+percutaneous+vertebroplasty:+Technical+note.">3-Dimensional printing guide template assisted percutaneous vertebroplasty: Technical note.</a> Journal of Clinical Neuroscience. 52, 159-164 (2018).</li></ol>

皮皮椎骨成形术（PVP）被认为是治疗骨质椎骨压缩性骨折的最好方法之一，因为它有一些明显的优点：它是微创的;出血较少，恢复迅速。传统的PVP主要由C-arm荧光镜引导，需要反复的荧光镜来确定安全和理想的穿刺点、穿刺角度和方向，这增加了术中辐射剂量和操作时间10.此外，手术的成功率主要取决于外科医生的经验。然而，仍然有1.2%-15.7%的错误率和0-7.42%?...

骨质疏松性骨折（OVCF）作为各种骨质疏松性骨折中最常见的类型性骨折，是当今临床上备受关注的临床问题。根据目前的指南建议，皮皮椎骨成形术是临床治疗骨质椎骨压缩性骨折1最有效的微创方法之一。
传统上，外科医生在C-arm荧光镜的指导下进行皮下椎骨整形手术，以治疗椎骨压缩性骨折，以恢复压缩的椎体，缓解早期疼痛2。即使是有经验的外科医生，只要依靠个人经验，就能在确认合适的穿孔点时出错。此操作可能导致一些与穿刺相关的并发症（例如，水泥渗入周围组织、神经根损伤、脊髓内造脑肿等3、4、5）;此外，近50%的患者有局部并发症从传统的PVP与95%的并发症来自水泥泄漏到周围组织或栓塞静脉6。随着精密手术的出现，三维打印指南模板已用于许多脊柱手术7，因为它可以提高程序的准确性，减少难度，并尽量减少操作风险。在这里，我们将三维打印指南模板应用于PVP，使外科手术更加精确，并降低穿刺相关并发症的发生率。与传统方法相比，3D打印指南模板辅助手术有1）手术穿刺精度提高，2）手术过程中辐射暴露最小化，3）缩短手术时间，4）减少手术时间。穿刺相关并发症的概率。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>X-ray machine</td>
			<td>Company Philips</td>
			<td></td>
			<td>machine</td>
		</tr>
		<tr>
			<td>Magnetic resonance image machine</td>
			<td>Company GE</td>
			<td></td>
			<td>machine</td>
		</tr>
		<tr>
			<td>computer tomography</td>
			<td>Company GE</td>
			<td></td>
			<td>machine</td>
		</tr>
		<tr>
			<td>HORI 3D printing machine</td>
			<td>Company of Beijing Huitianwei Technology co. ltd.</td>
			<td></td>
			<td>machine</td>
		</tr>
		<tr>
			<td>Geomagic Design X</td>
			<td>3D Systems Company</td>
			<td></td>
			<td>software</td>
		</tr>
		<tr>
			<td>Materialise Interactive Medical Image Control System</td>
			<td>Materialise Company</td>
			<td></td>
			<td>software</td>
		</tr>
		<tr>
			<td>VertePort needle</td>
			<td>Stryker Company</td>
			<td></td>
			<td>operation appliance</td>
		</tr>
		<tr>
			<td>Spineplex</td>
			<td>Stryker Company</td>
			<td></td>
			<td>operation appliance</td>
		</tr>
		<tr>
			<td>Percutaneous Cement Delivery System</td>
			<td>Stryker Company</td>
			<td></td>
			<td>operation appliance</td>
		</tr>
		<tr>
			<td>Spirit Level Plus</td>
			<td>IOS App store</td>
			<td></td>
			<td>gradientor</td>
		</tr>
	</tbody>
</table>

three-dimensional printing guide template assisted percutaneous vertebroplasty (pvp)

皮下椎骨成形术（PVP）被认为是骨质椎骨压缩性骨折引起的背痛的有效治疗。PVP的准确性主要取决于外科医生在传统手术中的经验和多荧光镜。世界各地都报告了穿刺相关的并发症。为了使手术更加精确，降低穿刺相关并发症的发生率，我们的团队对PVP应用了三维打印指南模板来修改传统程序。该协议介绍了如何在软件中将目标椎骨DICOM成像数据建模为三维，如何模拟此三维模型中的操作，以及如何利用所有手术数据重建患者特定的应用模板。使用此模板，外科医生可以准确地识别合适的穿刺点，以提高手术的准确性。整个方案包括：1）骨质椎骨压缩性骨折的诊断;2） 目标椎骨CT成像的采集;3）模拟软件中的操作;4）设计制作三维打印导板模板;5） 将模板应用到操作过程中。

医院对CT图像进行采集和数字建模，在3D打印公司进行三维打印。从 CT 图像重建三维打印的 3D 模型需要 30 分钟，三维打印公司需要大约 6 小时才能打印出 2 个指南模板并发送到医院。
患者目标椎骨的手术前图像如图1和图2：X射线（A1：后视;A2：横向视图）;磁共振图像（A3：TIWI 视图...

Watch this Scientific Journal Video about Three-Dimensional Printing Guide Template Assisted Percutaneous Vertebroplasty PVP at JoVE.com

Three-Dimensional Printing Guide Template Assisted Percutaneous Vertebroplasty PVP

在这里，我们提出了一个三维打印指南模板的皮椎骨。T11椎骨压缩性骨折患者被选择作为案例研究。

三维打印指南模板辅助皮椎间盘（PVP）

Percutaneous vertebroplasty (PVP) is considered an effective treatment for the back pain caused by osteoporotic vertebral compression fracture. The ...

我们的协议利用 3D 打印指南模板辅助皮皮顶骨骨折，促进骨折椎骨的全面可视化，并为患者制定个性化的手术计划。此技术有助于提高穿刺精度，减少与穿刺相关的并发症，最大限度地减少手术时间和辐射暴露，并缩短新手外科医生的 PVP 学习过程。可视化演示可以提供清晰、分步介绍，强调该技术的重要部分，便于快速掌握该方法。在开始手术之前，在患者背部的目视检查中，通过 X 射线荧光镜检查确认目标区域。接下来，在压缩的椎骨水平上沿患者后部皮肤的中线放置三个放射性标记，并放置一个渐变器，其位置低于固定标记。然后在移除梯度器之前记录患者的身体位置，并获取目标椎骨的计算断层扫描图像。在采集结束时，以 DICOM 格式保存图像，并在患者背部放置棉垫，以确保标记在手术前保持有效。获取计算机断层扫描图像后，将图像导入适当的医学成像处理软件程序，并选择目标切片以重建压缩椎骨。选择阈值分割可调整目标椎骨的阈值范围，从 125-3071H 开始，并创建一个蒙版。单击"重复蒙版"制作两个蒙版，蒙版 A 和蒙版 B.单击蒙版编辑以擦除蒙版 A 中的目标椎骨。单击布尔操作，并使用蒙版 B 减去蒙版 A 以形成新的蒙版 C.然后单击"从蒙版计算 3D"以重建目标椎骨。要通过双边交叉法模拟皮状性透镜成形术，请将软件中的 MedCAD 圆柱体定义为穿刺针模式，其长度和半径与穿刺针相同。使用目标椎骨的 3D 视图来可视化入口点、入口角度和穿刺针深度，实现真正的皮皮顶骨成形术，使用移动和旋转功能将穿刺针调整到理想位置。然后使用这些模板指南数据打印三维聚乳酸指南模板。对于 3D 打印的指南模板辅助 PVP，患者容易躺在与渐变器记录的计算断层扫描相同的位置，测量三个无线电标记的距离，并绘制三个标记的轮廓，以匹配模板与目标位置。将皮肤模板与皮肤轮廓匹配，并通过模板的针轨迹插入两个棉签，以标记皮肤上的插入点。将插入点标记为点 A 和 B.在拖曳手术区域后，将消毒胶带放在皮肤上，并在插入点处放置两根穿刺针的尖端。使用 C 臂荧光镜的后柱视图来确认模板确定的穿刺点是否可行。局部麻醉后，通过模板的引导油缸插入两根针，将两根针稍微插入目标椎骨，并使用 C 臂荧光镜验证轨迹是否足以插入。在用胶带打针之前，请确保标点符号在柱中，以推进提示，直到轨迹结束。当针头完全插入导向油缸时，使用 C 臂荧光镜验证针头尖端是否已达到最佳位置。然后通过每根针将两毫升的骨水泥注射到椎骨体内。并使用荧光镜检查骨骼体内水泥的分布，通过前柱和侧视图。手术前、后体和侧 X 射线图像显示，3D 引导模板辅助 PVP 前有代表性患者的目标椎骨。从日冕、横向和下垂平面获取的计算断层扫描图像可用于生成目标椎骨的 3D 模型。可以确定模板的导向油缸的长度，也可以制造模板，供 PVP 过程使用。为了整个手术的成功，必须将模板与患者背部的矫正位置相匹配。

Research

JoVE Journal

Medicine

Three-Dimensional Printing Guide Template Assisted Percutaneous Vertebroplasty (PVP)

Guide Wire Assisted Catheterization and Colored Dye Injection for Vascular Mapping of Monochorionic Twin Placentas

导丝辅助导管和彩色染料注射的双人单绒毛膜胎盘血管映射

Monochorionic (MC) twin pregnancies are associated with significantly higher morbidity and mortality rates than dichorionic twins. Approximately 50% of MC ...

科研

医学

Three-dimensional Imaging of Nociceptive Intraepidermal Nerve Fibers in Human Skin Biopsies

三维成像伤害表皮内神经纤维在人体皮肤活检

A punch biopsy of the skin is commonly used to quantify intraepidermal nerve fiber densities (IENFD) for the diagnosis of peripheral polyneuropathy 1,2. ...

Quantification of Breast Cancer Cell Invasiveness Using a Three-dimensional (3D) Model

Quantification of Breast Cancer Cell Invasiveness Using a Three-dimensional 3D Model

乳腺癌细胞侵袭定量使用三维（3D）模型

It is now well known that the cellular and tissue microenvironment are critical regulators influencing tumor initiation and progression. Moreover, the ...

Accuracy in Dental Medicine, A New Way to Measure Trueness and Precision

精度在牙科医学，一种新的方法来测量正确度与精密度

Reference scanners are used in dental medicine to verify a lot of procedures. The main interest is to verify impression methods as they serve as a base ...

Three-dimensional Co-culture Model for Tumor-stromal Interaction

对于肿瘤基质相互作用的三维共培养模式

Cancer progression (initiation, growth, invasion and metastasis) occurs through interactions between malignant cells and the surrounding tumor stromal ...

Three-Dimensional (3D) Tumor Spheroid Invasion Assay

Three-Dimensional 3D Tumor Spheroid Invasion Assay

三维（3D）肿瘤球体侵袭试验

Invasion of surrounding normal tissues is generally considered to be a key hallmark of malignant (as opposed to benign) tumors. For some cancers in ...

Three-dimensional Alginate-bead Culture of Human Pituitary Adenoma Cells

人垂体腺瘤细胞的三维海藻酸钠珠文化

A three-dimensional culture method is described in which primary pituitary adenoma cells are grown in alginate beads. Alginate is a polymer derived from ...

Three-Dimensional Printing of a Complex Aortic Anomaly

复杂主动脉异常的三维打印

Complex congenital aortic anomalies include diverse types of malformations that may be clinically asymptomatic or present with respiratory or esophageal ...

Three-Dimensional Collagen Matrix Scaffold Implantation as a Liver Regeneration Strategy

三维胶原基质支架植入作为肝脏再生策略

Liver diseases are the leading cause of death worldwide. Excessive alcohol consumption, a high-fat diet, and hepatitis C virus infection promote fibrosis, ...

Guided Endodontics: Three-Dimensional Planning and Template-Aided Preparation of Endodontic Access Cavities

引导牙髓病学：牙髓通路腔的三维规划和模板辅助制备

Pulp canal obliterations (PCO) are often a consequence of dental trauma, such as luxation injuries. Even though dentin apposition is a sign of vital pulp, ...