{"title":"解剖学惰性人手 3D 模型：可行性研究。","authors":"Noé Lucchino , Jean-Baptiste Pialat , Christophe Marquette , Edwin Courtial , Lionel Erhard , Delphine Voulliaume , Ali Mojallal , Aram Gazarian","doi":"10.1016/j.hansur.2024.101709","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><p>Surgery for congenital malformation of the hand is complex and protocols are not available. Simulation could help optimize results.</p><p>The objective of the present study was to design, produce and assess a 3D-printed anatomical support, to improve success in rare and complex surgeries of the hand.</p></div><div><h3>Material and methods</h3><p>We acquired MRI imaging of the right hand of a 30 year-old subject, then analyzed and split the various skin layers for segmentation.</p><p>Thus we created the prototype of a healthy hand, using 3D multi-material and silicone printing devices, and drew up a printing protocol suitable for all patients.</p><p>We printed a base comprising bones, muscles and tendons, with a multi-material 3D printer, then used a 3D silicone printer for skin and subcutaneous fatty cell tissues in a glove-like shape.</p><p>To evaluate the characteristics of the prototype, we performed a series of dissections on the synthetic hand and on a cadaveric hand in the anatomy lab, comparing realism, ease of handling and the final result of the two supports, and evaluated their respective advantages in surgical and training contexts. A grading form was given to each surgeon to establish a global score.</p></div><div><h3>Results</h3><p>This evaluation highlighted the positive and negative features of the model. The model avoided intrinsic problems of cadavers, such as muscle rigidity or tissue fragility and atrophy, and enables the anatomy of a specific patient to be rigorously respected. On the other hand, vascular and nervous networks, with their potential anatomical variants, are lacking.</p><p>This preliminary phase highlighted the advantages and inconveniences of the prototype, to optimize the design and printing of future models. It is an indispensable prerequisite before performing studies in eligible pediatric patients with congenital hand malformation.</p></div><div><h3>Conclusion</h3><p>The validation of 3D-printed anatomical model of a human hand opens a large field of applications in the area of preoperative surgical planning.</p><p>The postoperative esthetic and functional benefit of such pre-intervention supports in complex surgery needs assessing.</p></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"43 3","pages":"Article 101709"},"PeriodicalIF":0.9000,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468122924000987/pdfft?md5=4e7513eb3d782b979a1374ee75fffa01&pid=1-s2.0-S2468122924000987-main.pdf","citationCount":"0","resultStr":"{\"title\":\"3D MODEL of an anatomically inert human hand: feasibility study\",\"authors\":\"Noé Lucchino , Jean-Baptiste Pialat , Christophe Marquette , Edwin Courtial , Lionel Erhard , Delphine Voulliaume , Ali Mojallal , Aram Gazarian\",\"doi\":\"10.1016/j.hansur.2024.101709\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objectives</h3><p>Surgery for congenital malformation of the hand is complex and protocols are not available. Simulation could help optimize results.</p><p>The objective of the present study was to design, produce and assess a 3D-printed anatomical support, to improve success in rare and complex surgeries of the hand.</p></div><div><h3>Material and methods</h3><p>We acquired MRI imaging of the right hand of a 30 year-old subject, then analyzed and split the various skin layers for segmentation.</p><p>Thus we created the prototype of a healthy hand, using 3D multi-material and silicone printing devices, and drew up a printing protocol suitable for all patients.</p><p>We printed a base comprising bones, muscles and tendons, with a multi-material 3D printer, then used a 3D silicone printer for skin and subcutaneous fatty cell tissues in a glove-like shape.</p><p>To evaluate the characteristics of the prototype, we performed a series of dissections on the synthetic hand and on a cadaveric hand in the anatomy lab, comparing realism, ease of handling and the final result of the two supports, and evaluated their respective advantages in surgical and training contexts. A grading form was given to each surgeon to establish a global score.</p></div><div><h3>Results</h3><p>This evaluation highlighted the positive and negative features of the model. The model avoided intrinsic problems of cadavers, such as muscle rigidity or tissue fragility and atrophy, and enables the anatomy of a specific patient to be rigorously respected. On the other hand, vascular and nervous networks, with their potential anatomical variants, are lacking.</p><p>This preliminary phase highlighted the advantages and inconveniences of the prototype, to optimize the design and printing of future models. 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引用次数: 0
摘要
目的：先天性手部畸形的手术非常复杂，目前还没有相关的手术方案。模拟有助于优化手术效果。本研究的目的是设计、制作和评估一种 3D 打印的解剖支架，以提高手部罕见复杂手术的成功率：我们获取了一名 30 岁受试者右手的核磁共振成像，并分析和分割了不同的皮肤层。我们使用三维多材料和硅胶打印设备制作了健康手的原型，并制定了适合所有患者的打印方案。我们使用多材料三维打印机打印了由骨骼、肌肉和肌腱组成的底座，然后使用三维硅胶打印机打印了手套形状的皮肤和皮下脂肪细胞组织。为了评估原型的特性，我们在解剖实验室对合成手和尸体手进行了一系列解剖，比较了两种支撑物的逼真度、易操作性和最终效果，并评估了它们在手术和培训方面各自的优势。给每位外科医生发放了一份评分表，以确定总体得分：结果：这次评估突出了模型的正反两方面特点。该模型避免了尸体固有的问题，如肌肉僵硬、组织脆弱和萎缩，并能严格遵守特定病人的解剖结构。另一方面，该模型缺乏潜在解剖变异的血管和神经网络。这一初步阶段强调了原型的优势和不便之处，以便优化未来模型的设计和打印。在对符合条件的先天性手部畸形儿科患者进行研究之前，这是一个不可或缺的先决条件：人体手部三维打印解剖模型的验证为术前手术规划领域开辟了广阔的应用前景。这种术前干预支持在复杂手术中的术后美学和功能益处需要评估。
3D MODEL of an anatomically inert human hand: feasibility study
Objectives
Surgery for congenital malformation of the hand is complex and protocols are not available. Simulation could help optimize results.
The objective of the present study was to design, produce and assess a 3D-printed anatomical support, to improve success in rare and complex surgeries of the hand.
Material and methods
We acquired MRI imaging of the right hand of a 30 year-old subject, then analyzed and split the various skin layers for segmentation.
Thus we created the prototype of a healthy hand, using 3D multi-material and silicone printing devices, and drew up a printing protocol suitable for all patients.
We printed a base comprising bones, muscles and tendons, with a multi-material 3D printer, then used a 3D silicone printer for skin and subcutaneous fatty cell tissues in a glove-like shape.
To evaluate the characteristics of the prototype, we performed a series of dissections on the synthetic hand and on a cadaveric hand in the anatomy lab, comparing realism, ease of handling and the final result of the two supports, and evaluated their respective advantages in surgical and training contexts. A grading form was given to each surgeon to establish a global score.
Results
This evaluation highlighted the positive and negative features of the model. The model avoided intrinsic problems of cadavers, such as muscle rigidity or tissue fragility and atrophy, and enables the anatomy of a specific patient to be rigorously respected. On the other hand, vascular and nervous networks, with their potential anatomical variants, are lacking.
This preliminary phase highlighted the advantages and inconveniences of the prototype, to optimize the design and printing of future models. It is an indispensable prerequisite before performing studies in eligible pediatric patients with congenital hand malformation.
Conclusion
The validation of 3D-printed anatomical model of a human hand opens a large field of applications in the area of preoperative surgical planning.
The postoperative esthetic and functional benefit of such pre-intervention supports in complex surgery needs assessing.
期刊介绍：
As the official publication of the French, Belgian and Swiss Societies for Surgery of the Hand, as well as of the French Society of Rehabilitation of the Hand & Upper Limb, ''Hand Surgery and Rehabilitation'' - formerly named "Chirurgie de la Main" - publishes original articles, literature reviews, technical notes, and clinical cases. It is indexed in the main international databases (including Medline). Initially a platform for French-speaking hand surgeons, the journal will now publish its articles in English to disseminate its author''s scientific findings more widely. The journal also includes a biannual supplement in French, the monograph of the French Society for Surgery of the Hand, where comprehensive reviews in the fields of hand, peripheral nerve and upper limb surgery are presented.
Organe officiel de la Société française de chirurgie de la main, de la Société française de Rééducation de la main (SFRM-GEMMSOR), de la Société suisse de chirurgie de la main et du Belgian Hand Group, indexée dans les grandes bases de données internationales (Medline, Embase, Pascal, Scopus), Hand Surgery and Rehabilitation - anciennement titrée Chirurgie de la main - publie des articles originaux, des revues de la littérature, des notes techniques, des cas clinique. Initialement plateforme d''expression francophone de la spécialité, la revue s''oriente désormais vers l''anglais pour devenir une référence scientifique et de formation de la spécialité en France et en Europe. Avec 6 publications en anglais par an, la revue comprend également un supplément biannuel, la monographie du GEM, où sont présentées en français, des mises au point complètes dans les domaines de la chirurgie de la main, des nerfs périphériques et du membre supérieur.
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