Parts From 3-D Printer Give Surgeon Chance to Practice
3-D列印提供醫師練刀機會
By Karen Weintraub

BOSTON – The surgeon held a translucent white plastic eye socket in each hand. Gently moving them away from each other, Dr. John Meara showed the distance between Violet Pietrok’s eyes at birth. Then he slid the sockets closer to demonstrate their positions 19 months later, after he had operated on her.
這位外科醫師兩手各拿一個白色不透明的塑膠眼眶。約翰．梅拉醫師輕輕地把兩個眼眶的距離拉開，展示薇奧蕾特．皮特洛克出生時兩眼的距離。接著他把兩個眼眶滑近，展示19個月後，他為她動手術後兩眼的距離。

Violet, now nearly 2, was born with a rare defect called a Tessier facial cleft. Her dark brown eyes were set so far apart, her mother says, that her vision was more like a bird of prey’s than a person’s. The bones that normally join to form the fetal face had not fused properly.
現在快兩歲的薇奧雷特有罕見的先天缺陷「面裂症」。她深棕色的眼睛間距很長，她的母親說，她的視野比較像猛禽，而不像人。正常情況下接合形成胎兒臉部的骨頭，沒有接合得很好。

Her parents, Alicia Taylor and Matt Pietrok of Oregon, sought out Dr. Meara at Boston Children’s Hospital because the plastic surgeon had performed four similar operations.
她的父母，俄勒岡州的艾莉西亞．泰勒和麥特．皮特洛克，找上波士頓兒童醫院的梅拉醫師，因為這位整形外科醫師曾做過四個類似手術。

Before he operated on Violet, Dr. Meara wanted a more precise understanding of her bone structure than he could get from an image on a screen. So he asked his colleague Dr. Peter Weinstock to print him a three-dimensional model of her skull.
梅拉希望在為薇奧蕾特動手術前，對薇奧蕾特骨骼結構的了解，要比他從螢幕影像得到的更精準。因此，他請同事彼得．溫斯托克醫師幫他列印她的頭蓋骨的三度空間模型。

That first model helped him to decide what might need to be done and to discuss his treatment plan with her family. Three more 3-D printouts allowed Dr. Meara to rotate the model skull, then cut and manipulate to determine the best way to push her eye sockets more than 2.5 centimeters closer together.
第一個模型能夠幫助他決定需要做什麼，並與她的家人討論治療計畫。另外三個3-D列印模型讓梅拉能轉動頭骨模型，然後切割和操作，以便決定把薇奧蕾特的眼眶拉近2.5公分以上的最佳方法。

Such 3-D-printed models are transforming care, giving surgeons new perspectives and opportunities to practice, and patients and their families a deeper understanding of complex procedures.
這類3-D列印模型改變了醫療照護，給外科醫師練習的新觀點和機會，也讓病人和他們的家人對於複雜的程序能有更深入的了解。

“There’s no doubt that 3-D printing is going to be disruptive medicine,” said Dr. Frank J. Rybicki, chief of medical imaging at the Ottawa Hospital. “It makes procedures shorter, it improves your accuracy,” he said.
渥太華醫院醫學影像部門主管法蘭克．萊比基說：「毫無疑問3-D列印將顛覆醫學。它縮短了程序，提高你的準確度。」

For now, the printer extrudes a layer of liquid plastic instead of ink. It adds a second layer, and then another, and a skull or rib cage slowly emerges. The same process can print layers of human cells, blood vessels, simple organs and bits of bone. A Utah boy’s life was saved last year by a 3-D-printed plastic splint that propped open his windpipe.
現在，印表機壓出一層液態塑膠，而不是噴出油墨。它加上第二層，然後再一層，一個頭骨或胸廓慢慢出現。同樣的過程可以列印一層層的人體細胞、血管、簡單的器官和小塊骨頭。去年猶他州一個男孩被3-D列印的塑膠片撐開氣管，救了他一命。

Dr. Weinstock, the director of the Pediatric Simulator Program at Boston Children’s, sees 3-D models as part of a larger program to improve surgical craft. At Children’s and a dozen other pediatric centers around the world, he says, the surgical simulation program he developed improves team communication and trust, and lifts confidence before extremely complex operations. Dr. Weinstock is convinced that the $400,000 3-D printer has prevented many errors.
波士頓兒童醫院小兒科模擬器計畫主任溫斯托克認為，3-D模型是改進外科技術這個更大計畫的一環。他說，在這家兒童醫院和全世界另外十幾家小兒科醫學中心，他發展的手術模擬計畫改進了團隊的溝通和信任，並在極複雜手術前提高信心。溫斯托克確信40萬美元的3-D印表機防止了很多錯誤。

The models of Violet’s unusual skull allowed Dr. Meara to anticipate what he would find.
有了薇奧蕾特異常頭蓋骨的這幾個模型，讓梅拉能夠預期他會找到什麼。

Dr. Meara had received printed models of other patients’ skulls before, but only after waiting weeks for a single replica, at a cost of thousands of dollars. Dr. Weinstock’s printer generated four copies in a few days, each costing about $1,200 and accurate to within a hair’s width.
梅拉之前也曾取得其他病人的頭蓋骨3-D列印模型，但要等上好幾周才拿到一個複製模型，而且得花數千美元。而溫斯托克的印表機在幾天之內便列印出四個複製模型，每個約只花費1200美元，而且十分精準。

Dr. Meara noticed that in their ideal positions, the bones of the eye sockets would bump into each other, limiting Violet’s vision. He modified his cuts to avoid that collision.
梅拉注意到，在眼眶理想的位置，兩個眼眶骨會互撞，限制薇奧蕾特的視野。他修正了他下刀的位置，避免碰撞。

“The ability to physically move those segments is huge,” Dr. Meara said. “Otherwise, you’re doing it for the first time in the operating room.”
梅拉說：「能實體移動這些部位的能力非常巨大。否則你在開刀房會是第一次做。」

On Violet’s surgery day in October, Dr. Meara consulted a model in the operating theater. The surgery went as planned.
在薇奧蕾特去年10月手術當天，梅拉在手術台上參考了一個模型。手術依計畫進行。

At Brigham and Women’s Hospital near Boston Children’s, an even more sophisticated 3-D printer replicates flesh as well as bone, and even prints the tools needed to make the cuts.
在波士頓兒童醫院附近的布萊根婦女醫院，更先進的3-D印表機列印出血肉和骨頭，甚至印出劃刀所需的工具。

“When it comes time to operate, you don’t need to fiddle around, it’s all there,” Dr. Rybicki said. “You have unprecedented surgical planning, and you have unprecedented accuracy.”
萊比基說：「手術的時間到了，你不必胡亂擺弄，全都準備好了。你的手術計畫是前所未見的，你的精準也是前所未見的。」

Comparing models from before and after surgery offers clues to why some tissue grafts take hold and some are rejected, Dr. Rybicki said.
萊比基說，比較手術前後的模型，為何以一些組織移植成功，一些卻被排斥提供了線索。

As 3-D printers improve, so will surgical outcomes, Dr. Rybicki said. Soon, doctors will thread catheters through replica blood vessels, map out how to bypass aneurysms, and feel the tactile difference between tumors and healthy tissue.
萊比基說，隨著3-D印表機進步，手術結果也會進步。很快的，醫師將把導管插入複製血管，規畫如何繞過動脈瘤，並感覺腫瘤和健康組織在觸感上的不同。

Violet’s parents, who have five other children, including Violet’s healthy twin, Cora, said they felt comforted by Dr. Meara’s extensive preparations.
薇奧蕾特的父母說，梅拉的周全準備讓他們很放心。他們另有五個孩子，包括薇奧蕾特健康的孿生姊妹可拉。

On the day of the operation, when the surgeon came out to speak with the family, “he was smiles from ear to ear,” Ms. Taylor said. “He said it went perfect.”
泰勒女士說，手術當天，當這位外科醫師出來和家人說話時，「他笑逐顏開，他說，手術完美。」

Knowing every move he would make, she added, was hugely different “from busting her open and saying, ‘How do we fix this?’ ”
她接著說，知道他要做的每一步，與「把她切開，然後說，『我們要如何搞定？』可是天壤之別。

原文參照：
http://www.nytimes.com/2015/01/27/science/off-the-3-d-printer-practice-parts-for-the-surgeon.html

2015-02-10聯合報/G5版/UNITED DAILY NEWS 田思怡譯 原文參見紐時週報十版上