个性化骨科手术中3D打印技术的临床应用与展望

doi:10.3877/cma.j.issn.1674-0785.2026.04.001

随着全球人口老龄化加剧及肌肉骨骼系统疾病高发，传统标准化骨科植入物的适配性缺陷愈发凸显，精准医疗驱动下个性化解决方案需求迫切。3D打印技术依托医学影像三维重建、个性化设计优化、多元材料适配及精准成型工艺，实现了骨科植入物从“通用”到“专用”的转变，可制备匹配患者解剖结构与力学需求的植入物、手术导板及解剖模型。该技术已广泛应用于关节置换、脊柱外科、骨肿瘤修复、创伤骨科及韧带重建等领域，显著提升手术精度、效率与功能结局。然而，其临床规模化应用仍面临技术可靠性不足、时间经济成本高昂、医疗体系监管与协作不完善等挑战。未来，随着与人工智能深度融合及4D打印技术发展，3D打印骨科植入物将向自适应、智能化方向演进，为个性化骨科医疗提供更全面的解决方案，推动诊疗模式革新。

关键词: 3D打印, 个性化治疗, 骨科

With the intensifying global aging population and the high incidence of musculoskeletal diseases, the adaptability limitations of traditional standardized orthopedic implants have become increasingly prominent, driving an urgent demand for personalized solutions under the precision medicine paradigm. Relying on medical imaging-based three-dimensional (3D) reconstruction, personalized design optimization, multi-material adaptation, and precise molding processes, 3D printing technology has transformed orthopedic implants from a "general-purpose" to a "special-purpose" paradigm, enabling the fabrication of implants, surgical guides, and anatomical models that precisely match patients' anatomical structures and mechanical requirements. This technology has been widely applied in joint replacement, spinal surgery, bone tumor repair, trauma orthopedics, and ligament reconstruction, significantly improving surgical precision, efficiency, and functional outcomes. However, its large-scale clinical application still faces challenges, including insufficient technical reliability, high time and economic costs, and imperfect medical regulatory oversight and interdisciplinary collaboration. In the future, with the deep integration of artificial intelligence and the development of 4D printing technology, 3D-printed orthopedic implants are expected to evolve towards self-adaptive and intelligent directions, providing more comprehensive solutions for personalized orthopedic medicine and driving innovation in diagnostic and treatment paradigms.

Key words: 3D printing, Personalized treatment, Orthopedics

图1 3D打印骨科植入物的制造流程

表1 3D打印成型工艺比较

工艺	工作原理	常用材料	优势	参考文献
VP	液态树脂单体或低聚物在暴露于特定光源下发生聚合	光敏树脂	打印速度快，可打印高分辨率结构，精度高	^[27]
ME	使用热塑性或黏弹性材料，通过喷嘴挤出并逐层沉积到基底上，通常使用加热的打印头	热塑性塑料	成本与能耗低、空间分辨率高、能够制造复杂结构	^[28]
DIW	工作原理与ME类似，但采用气动或机械方式在温和温度下挤出	塑料	精度高、空间分辨率高、可使用水凝胶材料	^[29]
PBF	使用热源（激光或电子束）选择性地熔融粉末材料的每一层	各种金属	可使用材料范围广、精度高、能够处理复杂几何形状	^[30]
SL	利用热量和黏合剂将连续的片材层黏合在一起，形成固结结构	复合材料	成本低、可快速制造大型部件	^[31]

表1 3D打印成型工艺比较

工艺	工作原理	常用材料	优势	参考文献
VP	液态树脂单体或低聚物在暴露于特定光源下发生聚合	光敏树脂	打印速度快，可打印高分辨率结构，精度高	^[27]
ME	使用热塑性或黏弹性材料，通过喷嘴挤出并逐层沉积到基底上，通常使用加热的打印头	热塑性塑料	成本与能耗低、空间分辨率高、能够制造复杂结构	^[28]
DIW	工作原理与ME类似，但采用气动或机械方式在温和温度下挤出	塑料	精度高、空间分辨率高、可使用水凝胶材料	^[29]
PBF	使用热源（激光或电子束）选择性地熔融粉末材料的每一层	各种金属	可使用材料范围广、精度高、能够处理复杂几何形状	^[30]
SL	利用热量和黏合剂将连续的片材层黏合在一起，形成固结结构	复合材料	成本低、可快速制造大型部件	^[31]

图2 3D打印模板辅助踝关节置换。图a为术前三维设计假体型号和假体位置；图b为术前3D打印个性化模板

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Three-demensional printing technology in personalized orthopedic surgery: applications and prospects

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Three-demensional printing technology in personalized orthopedic surgery: applications and prospects