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First 3D Printed Sacrum Implant

On 12th June 2016, in Beijing QingHua ChangGeng hospital operation room no.11, the 10 hour long operation successfully finished. Beijing QingHua ChangGeng hospital is a new affiliated hopsital of QingHua University, and is a general hospital that integrates medical, education, scientific research, prevention and recovery.

Professor XiongHua Xiao, director of the department of orthopedics, led physicans Fei Song and Ji Zhao to successsfully complete an operation for a patient with a sacrum 1-2 giant cellbone tumor by removing the whole high sacral tumor and embedding 3D printed custom prostheses, establishing pelvic stability, whilst successfully maintaining the use of lower limbs, bladder and bowel functions. This is the first time this has been done successfully.

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The patient is a father with two children, who had just celebrated his 30th birthday. A large tumor was found in the bone tissue of the upper part of his sacrum in April 2016, after some nerves had been aggravated by the tumour, which caused a lot of pain as well as a lack of movement. The Sacrum forms the fusion of 5 sacral vertebraes, connects lumbar spine and pelvis, and plays a significant role in connecting the torso to lower extremities.

According to professor Xiao, there are two therapeutic methods for large bone tumors. The first method is Excochleation, which is simple but has a high recurrence rate. Another method is full sacrectomy pelvic ring reconstruction surgery, which radically cures tumors but is highly difficult as there are few hosptials where this can be carried out. Moreover, this method requires the sacral nerve to be cut off, leaving patients with varying degrees of side effects, such as lower limb paralysis, incontinence, and sexual dysfunction.

So is it possible to provide a cure whilst improving the quality of life of the patient post-operation? Professor Xiao brought his team, communicated with the patient’s parents, and finally decided to explore a new method. Remove the whole upper sacral tumor and install 3D printed custom prostheses. On the premise of removing a tumor, this method maintains the quality of the patient’s life to the maximum extent whilst minimising the recurrence rate.

 

The team prepares for the first case in the world

After scanning the patient using a CT thin layer scanner and nuclear magnetic resource, the 3D printing team of QingHua ChangGeng hospital began their preoperative preparation. The physicans cooperated with technists, and rebuilt the pelvis three-dimensional structure, repeated calculations and combined with clincial practice, they designed 3D printed custom artificial sacral vertebra. Unlike general-purpose artificial vertebrae, the prosthesis are a custom type of titanium alloy implant, determined through repeated biology and mechanics tests. This was then applied to the human body, it completely fit the patients vertabral body shape, and it also has the unique design of a locking system.

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Tailor-made 3D printing

The Sacrum is located close to important viscera and iliac blood vessels. WeiWei Wu, the director of Vascular surgery, used tumour vascular embolization to avoid intraoperative bleeding, a day in advance. Director HaiMei Ma from Blood transfusion department, coordinated and allocated 20 units of red blood cell and 20 units of fresh plasma for backup and Physicans Huan Zhang and YanJun Zhao from the anesthesia department, prepared anesthesia and monitored operations before the operation. Everything was fully prepared, a hard and challenging surgery was about to begin.

The operation comprised of three steps, the first step was to protect the internal organs and blood vessels, open the bilateral retroperitoneal separation, protect the normal tissues and to determine the bone cutting plane on both sides of the sacroiliac joint, thus guaranteeing the entire tumor tissues complete removal, whilst reducing the tumour’s recurrence rate.

The second step was to turn the posterior, connect line L345 with iliac screws, remove the vertebral plate from the back whole block, and make sure the rear bone cutting plane was correct and prepare connect the front and the back.

The third step was connect to back to the front again, from retroperitoneal blocks to remove the right side of the vertebral body and tumor surrounding the S1 nerve root, bypass, then embed 3D the printed custom prosthesis, fixing in the locking mechanism after matching.
The operation finished at 2am. During the operation, nurses changed 3 times, the patient’s body was turned over 2 times, and the operation lasted 10 hours. There was no vital sign fluctuation, and the patient was revived few hours after the operation.  Now he can walk and go to bathroom normally, and after a review of the x-ray, the prosthetic joint was installed perfectly.