The Second Department of Orthopedics, Xi’an Third Hospital
Successfully completed the first case in a municipal hospital
Pelvic tumor 3D printing guide plate-assisted hemipelvic resection 3D printing modular hemipelvic prosthesis replacement
Maximum preservation of lower extremity function for patients
Improve patient quality of life
With the development of medical imaging technology, 3D printing technology has appeared more and more in the diagnosis and treatment of orthopedic diseases, and has shown its unique advantages. It can replicate the bones, blood vessels and nerves of the human body in equal proportions. Clinicians can gain a more three-dimensional and intuitive understanding of the patient’s anatomical structure and provide the most direct imaging data for disease diagnosis and treatment.
However, this technology has extremely high requirements on imaging technology, prosthesis design technology and orthopaedic surgeons’ surgical skills. Currently, there are still a few medical centers that can apply 3D printing technology to the diagnosis and treatment of bone tumor diseases. Northwestern University Affiliated Hospital • Xi’an No. 1 Under the leadership of Professor Wang Zhen from the Department of Orthopaedic Oncology, Xijing Hospital Affiliated to Air Force Military Medical University, the team of Director Fu Zhanli of the Second Department of Orthopedics of the Third Hospital has completed the “3D printed knee replacement for osteosarcoma” and the first case of “osteosarcoma” in Xi’an municipal hospital. After 3D printing wrist joint replacement surgery” and the first “children’s osteosarcoma 3D printing shoulder joint replacement surgery” in Xi’an municipal hospital, he completed the pioneering work again, and successfully completed the first “3D printing guide-guided pelvic tumor resection 3D printing in Xi’an municipal hospital” Modular semi-pelvic artificial prosthesis replacement”, bravely breaking into the restricted area of orthopedic surgery, bringing new hope to patients with bone tumors, and making the hospital stand at the pinnacle of bone tumor disease treatment again.
Recently, the No. 2 Orthopedics Ward of Northwestern University Affiliated Hospital • Xi’an Third Hospital admitted a patient with a huge and complex pelvic tumor. After biopsy, the tumor was determined to be pelvic chondrosarcoma. According to Director Fu Zhanli, chondrosarcoma has a high degree of malignancy and is not sensitive to radiotherapy and chemotherapy. It must be radically removed during surgical resection, otherwise recurrence, distant metastasis or local bone destruction will occur. In this patient, the right pelvis had been completely eroded by the tumor, and the tumor had invaded the adjacent muscle tissue. The operation required complete resection of the right pelvis. The role of the pelvis not only accommodates and protects the pelvic organs, but also supports and transmits gravity. Due to the extremely complex anatomical structure of the pelvis, the risk of surgery is high, and life is at risk at any time. Under the guidance of Professor Wang Zhen, a famous bone tumor expert in my country, under the organization of the Medical Department, the Second Orthopedics Department, together with the imaging department, pathology department, blood transfusion department, anesthesiology department, operating room and general medical staff, conducted MTD multidisciplinary discussions on surgery and nursing. The plan, combined with the detailed physical examination and the patient’s imaging data, decided to take a huge risk to solve the patient’s pain.
Preoperative pelvic X-ray
Preoperative pelvic CT scan
Preoperative pelvic MRI
preoperative condition discussion
Hospital-wide MTD discussion before surgery
Before the operation, Director Fu Zhanli led Deputy Chief Physician Li Bing and Chief Physician Li Cheng to check the patient
According to Director Fu Zhanli, the initial treatment for pelvic malignancies was hemipelvic amputation, which seriously affected the patient’s quality of life and endangered life safety. However, conventional tumor prostheses are difficult to completely match the patient’s anatomical structure, which also increases the difficulty of the operation. During the operation, the patients have more bleeding, the operation time is long, the risk of infection is increased, and the postoperative limb function recovery is poor. ; With the rise of 3D printing technology and the further development of the combination of medicine and engineering, it is possible to customize the pelvic prosthesis.
After the discussion, Director Fu Zhanli led the team to customize a personalized treatment plan for him. Under the guidance of Professor Wang Zhen, he finally decided to carry out “3D printing guide-guided pelvic tumor resection 3D printing modular semi-pelvic artificial surgery for the patient. “Prosthesis replacement surgery”, using 3D CT data to design a customized 3D printed tumor-type artificial pelvic prosthesis, and design a one-to-one model of the osteotomy guide during intraoperative pelvic replacement according to the size and location of the patient’s tumor. While the tumor is completely removed, the intraoperative osteotomy efficiency is greatly improved, the operation time is shortened, the infection risk is reduced, and the patient’s life safety is guaranteed.
Before the operation, the medical staff of the Second Orthopaedic Department discussed the general case again, and head nurse He Jing led the nursing team to formulate a detailed perioperative care plan to ensure the safety of patients during the perioperative period. .
The corresponding osteotomy position is designed according to the patient’s preoperative CT examination
Design the corresponding prosthesis shape and determine the appropriate screw position and length
3D printing modular semi-pelvic prosthesis
3D printed modular hemipelvic prosthesis completes replacement on 3D printed pelvis
Considering that there may be more bleeding during the operation, and the patient is from other places and has no relatives in Xi’an, Director Fu Zhanli actively mobilized the medical staff of the department to donate blood to ensure the safety of life during the operation. After sufficient preoperative preparation, Director Fu Zhanli, Deputy Chief Physician Li Bing, and Chief Physician Li Cheng of the Second Orthopedics Department, under the guidance of Professor Wang Zhen of Xijing Hospital, and with the full cooperation of the Department of Anesthesiology, the operating room and the Department of Blood Transfusion, provided patients with Perform surgical treatment. The operation was very smooth. The tumor was completely removed during the operation. The 3D-printed anatomical pelvic tumor prosthesis perfectly replaced the right half of the pelvis. The pelvic prosthesis and the artificial femoral head were well wrapped. The operation lasted 4 hours and the intraoperative blood loss was 1000ml. Compared with the traditional pelvic replacement surgery that took more than ten hours and blood loss of several thousand milliliters in the past, the operation time was greatly shortened, the intraoperative risk was reduced, and a solid foundation was laid for the patient’s postoperative recovery.
Intraoperative complete tumor resection
Intraoperative C-arm fluoroscopy showed the proper position of the prosthesis
It is believed that with the continuous improvement of 3D printing technology, more and more bone tumor patients will benefit from it. It has always been the pursuit of the Second Department of Orthopedics of Xi’an Third Hospital to make the restricted area of orthopedics no longer a restricted area, and to improve the quality of life of patients with bone tumors!
Source: Xi’an Third Hospital