대한정형외과학회지 (Journal of the Korean Orthopaedic Association)

  • 제53권6호
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  • Pages.466-477
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  • 2018
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  • 1226-2102(pISSN)
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  • 2005-8918(eISSN)
대한정형외과학회 (Korean Orthopaedic Association)
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3차원 프린팅 기술과 이를 활용한 골종양 수술

Three Dimensional Printing Technique and Its Application to Bone Tumor Surgery

  • 강현귀 (국립암센터 골연부종양클리닉) ;
  • 박종웅 (국립암센터 골연부종양클리닉) ;
  • 박대우 (국립암센터 혁신의료기술연구과)
  • Kang, Hyun Guy (Orthpaedic Oncology Clinic, National Cancer Center) ;
  • Park, Jong Woong (Orthpaedic Oncology Clinic, National Cancer Center) ;
  • Park, Dae Woo (Innovative Medical Engineering and Technology, National Cancer Center)
  • 투고 : 2017.11.01
  • 심사 : 2018.03.15
  • 발행 : 2018.12.30
⟨ 이전 논문 다음 논문 ⟩

초록

정형외과는 인체의 모든 근골격계를 담당하기 때문에 3차원(3-dimensional, 3D) 프린팅 기술을 가장 많이 활용할 수 있는 분야이다. 구체적으로 관절염, 척추, 외상, 기형, 종양 등의 다양한 정형외과 질병에 대해 해부학적 모델, 수술용 가이드, 금속 임플란트, 바이오-세라믹 재건, 보조기 등의 형태로 활용될 수 있다. 특히 정형외과 종양 영역은 환자마다 종양의 발생 위치와 크기가 다양한 데 반하여 사지 보존 수술에 활용할 수 있는 기존의 수술 방법이 제한적이었기 때문에 3D 프린팅 기술의 활용이 매우 절실한 분야였다. 최근에 3D 프린팅 환자 맞춤형 임플란트를 짧은 시간 내에 쉽게 제작할 수 있게 되면서 기존 방법으로 골 재건이 어려웠던 부위에 대해서도 해부학적 재건이 가능하게 되었다. 3D 프린팅 기술을 의료 영역에서 더욱 폭넓게 사용하기 위해서는 디자인, 출력, 검증 과정에 필요한 많은 전문가들과 함께 수평적 위치에서 긴밀히 협력해야 한다. 의료계에서 3D 프린팅을 활용을 선도함으로써 다른 분야의 전문가 양성 및 3D 프린팅 관련 산업의 발달을 촉진시킬 수 있다고 판단한 정부도 규제보다는 활성화에 역점을 두고 적극적으로 지원하고 있는 추세이다. 앞으로 정형외과가 전체 의료계에서 3D 프린팅 기술의 도입과 활용을 선도해 가기를 기대하면서 골종양 수술에서 3D 프린팅 기술을 활용하였던 저자의 경험을 소개하고자 한다.

Orthopaedics is an area where 3-dimensional (3D) printing technology is most likely to be utilized because it has been used to treat a range of diseases of the whole body. For arthritis, spinal diseases, trauma, deformities, and tumors, 3D printing can be used in the form of anatomical models, surgical guides, metal implants, bio-ceramic body reconstruction, and orthosis. In particular, in orthopaedic oncology, patients have a wide variety of tumor locations, but limited options for the limb salvage surgery have resulted in many complications. Currently, 3D printing personalized implants can be fabricated easily in a short time, and it is anticipated that all bone tumors in various surgical sites will be reconstructed properly. An improvement of 3D printing technology in the healthcare field requires close cooperation with many professionals in the design, printing, and validation processes. The government, which has determined that it can promote the development of 3D printing-related industries in other fields by leading the use of 3D printing in the medical field, is also actively supporting with an emphasis on promotion rather than regulation. In this review, the experience of using 3D printing technology for bone tumor surgery was shared, expecting orthopaedic surgeons to lead 3D printing in the medical field.

키워드

과제정보

연구 과제 주관 기관 : 한국보건산업진흥원

참고문헌

  1. Hoang D, Perrault D, Stevanovic M, Ghiassi A. Surgical applications of three-dimensional printing: a review of the current literature & how to get started. Ann Transl Med. 2016;4:456. https://doi.org/10.21037/atm.2016.12.18
  2. Petzold R, Zeilhofer HF, Kalender WA. Rapid protyping technology in medicine--basics and applications. Comput Med Imaging Graph. 1999;23:277-84. https://doi.org/10.1016/S0895-6111(99)00025-7
  3. Kim GB, Lee S, Kim H, et al. Three-dimensional printing: basic principles and applications in medicine and radiology. Korean J Radiol. 2016;17:182-97. https://doi.org/10.3348/kjr.2016.17.2.182
  4. Lee S. Prospect for 3D printing technology in medical, dental, and pediatric dental field. J Korean Acad Pediatr Dent. 2016;43:93-108.
  5. Byrne N, Velasco Forte M, Tandon A, Valverde I, Hussain T. A systematic review of image segmentation methodology, used in the additive manufacture of patient-specific 3D printed models of the cardiovascular system. JRSM Cardiovasc Dis. 2016;5:2048004016645467.
  6. Park JH, Lee Y, Shon OJ, Shon HC, Kim JW. Surgical tips of intramedullary nailing in severely bowed femurs in atypical femur fractures: simulation with 3D printed model. Injury. 2016;47:1318-24. https://doi.org/10.1016/j.injury.2016.02.026
  7. Chung KJ, Hong DY, Kim YT, Yang I, Park YW, Kim HN. Preshaping plates for minimally invasive fixation of calcaneal fractures using a real-size 3D-printed model as a preoperative and intraoperative tool. Foot Ankle Int. 2014;35:1231-6. https://doi.org/10.1177/1071100714544522
  8. Jeong HS, Park KJ, Kil KM, et al. Minimally invasive plate osteosynthesis using 3D printing for shaft fractures of clavicles: technical note. Arch Orthop Trauma Surg. 2014;134:1551-5. https://doi.org/10.1007/s00402-014-2075-8
  9. Parchi PD, Ferrari V, Piolanti N, et al. Computer tomography prototyping and virtual procedure simulation in difficult cases of hip replacement surgery. Surg Technol Int. 2013;23:228-34.
  10. Cherkasskiy L, Caffrey JP, Szewczyk AF, et al. Patient-specific 3D models aid planning for triplane proximal femoral osteotomy in slipped capital femoral epiphysis. J Child Orthop. 2017;11:147-53. https://doi.org/10.1302/1863-2548-11-170277
  11. Qiao F, Li D, Jin Z, Hao D, Liao Y, Gong S. A novel combination of computer-assisted reduction technique and three dimensional printed patient-specific external fixator for treatment of tibial fractures. Int Orthop. 2016;40:835-41. https://doi.org/10.1007/s00264-015-2943-z
  12. Qiao F, Li D, Jin Z, et al. Application of 3D printed customized external fixator in fracture reduction. Injury. 2015;46:1150-5. https://doi.org/10.1016/j.injury.2015.01.020
  13. Shuang F, Hu W, Shao Y, Li H, Zou H. Treatment of intercondylar humeral fractures with 3D-printed osteosynthesis plates. Medicine (Baltimore). 2016;95:e2461. https://doi.org/10.1097/MD.0000000000002461
  14. Chung SS, Lee KJ, Kwon YB, Kang KC. Characteristics and efficacy of a new 3-dimensional printed mesh structure titanium alloy spacer for posterior lumbar interbody fusion. Orthopedics. 2017;40:e880-5. https://doi.org/10.3928/01477447-20170810-04
  15. Li H, Qu X, Mao Y, Dai K, Zhu Z. Custom acetabular cages offer stable fixation and improved hip scores for revision THA with severe bone defects. Clin Orthop Relat Res. 2016;474:731-40. https://doi.org/10.1007/s11999-015-4587-0
  16. Kaneyama S, Sugawara T, Sumi M. Safe and accurate midcervical pedicle screw insertion procedure with the patient-specific screw guide template system. Spine (Phila Pa 1976). 2015;40:E341-8. https://doi.org/10.1097/BRS.0000000000000772
  17. Chen H, Guo K, Yang H, Wu D, Yuan F. Thoracic pedicle screw placement guide plate produced by three-dimensional (3-D) laser printing. Med Sci Monit. 2016;22:1682-6. https://doi.org/10.12659/MSM.896148
  18. Chen H, Wu D, Yang H, Guo K. Clinical use of 3D printing guide plate in posterior lumbar pedicle screw fixation. Med Sci Monit. 2015;21:3948-54. https://doi.org/10.12659/MSM.895597
  19. Hirao M, Ikemoto S, Tsuboi H, et al. Computer assisted planning and custom-made surgical guide for malunited pronation deformity after first metatarsophalangeal joint arthrodesis in rheumatoid arthritis: a case report. Comput Aided Surg. 2014;19:13-9. https://doi.org/10.3109/10929088.2014.885992
  20. Imanishi J, Choong PF. Three-dimensional printed calcaneal prosthesis following total calcanectomy. Int J Surg Case Rep. 2015;10:83-7. https://doi.org/10.1016/j.ijscr.2015.02.037
  21. Wei R, Guo W, Ji T, Zhang Y, Liang H. One-step reconstruction with a 3D-printed, custom-made prosthesis after total en bloc sacrectomy: a technical note. Eur Spine J. 2017;26:1902-9. https://doi.org/10.1007/s00586-016-4871-z
  22. Wong KC, Kumta SM. Joint-preserving tumor resection and reconstruction using image-guided computer navigation. Clin Orthop Relat Res. 2013;471:762-73. https://doi.org/10.1007/s11999-012-2536-8
  23. Wong KC, Kumta SM, Geel NV, Demol J. One-step reconstruction with a 3D-printed, biomechanically evaluated custom implant after complex pelvic tumor resection. Comput Aided Surg. 2015;20:14-23. https://doi.org/10.3109/10929088.2015.1076039
  24. Wong KC, Kumta SM, Sze KY, Wong CM. Use of a patient-specific CAD/CAM surgical jig in extremity bone tumor resection and custom prosthetic reconstruction. Comput Aided Surg. 2012;17:284-93. https://doi.org/10.3109/10929088.2012.725771
  25. Fletcher CD, Bridge JA, Hogendoorn PCW. WHO classification of tumours of soft tissue and bone. Lyon: International Agency for Research on Cancer; 2013.
  26. Wong KC, Kumta SM, Leung KS, Ng KW, Ng EW, Lee KS. Integration of CAD/CAM planning into computer assisted orthopaedic surgery. Comput Aided Surg. 2010;15:65-74. https://doi.org/10.3109/10929088.2010.514131
  27. Wong KC, Sze KY, Wong IO, Wong CM, Kumta SM. Patient-specific instrument can achieve same accuracy with less resection time than navigation assistance in periacetabular pelvic tumor surgery: a cadaveric study. Int J Comput Assist Radiol Surg. 2016;11:307-16. https://doi.org/10.1007/s11548-015-1250-x