La recente notizia del successo di un intervento su bimbi affetti da tracheobroncomalacia (TBM) pone sotto i riflettori le stampanti 3D. Come funzionano questi macchinari e qual è la loro utilità in ambito medico-chirurgico.

Kaiba è stato il primo bambino a ricevere lo splint
Kaiba è stato il primo bambino a ricevere lo splint

La tracheobroncomalacia è una patologia che colpisce le cartilagini di trachea e bronchi e che determina il cedimento di queste strutture, impedendo ogni passaggio di aria da e verso i polmoni. I pazienti affetti rischiano di andare incontro ad arresto cardiopolmonare, condizione che mette a rischio la loro sopravvivenza. Nel 2012 è stato impiantato per la prima volta dall’equipe medica guidata dal dott. G. Green e dal dott. S. Hollister del C.S. Mott Children’s Hospital, un dispositivo o splint (immagine di copertina) ottenuto mediante una stampante 3D in un bambino di 2 mesi. Questo supporto, costituito da un materiale biocompatibile e bioriassorbibile, è stato “cucito” intorno al bronco e ne permette l’espansione ed il mantenimento della forma, evitando il collasso e permettendo il passaggio di aria.  Sono passati tre anni da quel giorno e lo splint è stato riassorbito. Nel frattempo sono stati operati altri due bambini con la stessa tecnica ed i risultati sono ottimi: i tre piccoli pazienti stanno benissimo, riescono a respirare autonomamente senza che questa azione, così naturale e vitale, sia dannosa.

Tutto ciò è stato possibile grazie all’ingegno dei medici e alla possibilità di utilizzare un particolare strumento: la stampante 3D. Questo macchinario rappresenta una delle più importanti innovazioni dei nostri tempi, diventando di grandissima utilità in diversi campi: dall’edilizia e al design fino alla medicina. In quest’ultima branca, le conoscenze finora acquisite, vengono sfruttate per la riparazione di difetti anatomici a carico di un particolare organo (come nel caso sopracitato) o per la realizzazione protesi personalizzate. In particolare la chirurgia cranio maxillo facciale si serve di questa metodica in casi di traumi, oppure di alterazioni del massiccio facciale o della scatola cranica dovute a varie patologie.

Ancora, questa tecnologia è alla base della tissue engineering: con le stampanti 3D si è in grado di realizzare delle vere e proprie impalcature su cui andare ad impiantare cellule in grado di proliferare e popolare queste strutture. L’obiettivo è quello di ottenere dei tessuti funzionanti dal punto di vista chimico e biologico che possano sostituire o integrare la normale attività di quelli del nostro organismo in caso di danno.

Senza voler entrare troppo nei dettagli e nei tecnicismi, il funzionamento di questi strumenti è paragonabile a quello di una classica stampante che tutti noi utilizziamo per i nostri documenti: il punto di partenza è sempre l’immagine, con la differenza che ciò che si ottiene non è un foglio di carta, ma un modello tridimensionale. In medicina, i dati forniti alla macchina sono rappresentati da reperti di imaging, in particolare tac e risonanza magnetica, che rappresentano i metodi di visualizzazione attualmente più precisi. Una volta acquisite tutte le informazioni, il modello viene progettato su di un computer e personalizzato sulle caratteristiche del paziente. La stampa avviene strato per strato e l’oggetto può eventualmente andare incontro a processi di post-produzione.

L’ “inchiostro” di questa stampante è rappresentato da materiali biocompatibili, ovvero altamente tollerati e non dannosi per l’organismo, che hanno ricevuto l’approvazione dalla FDA (Food and Drug Administration). Quelli più comunemente utilizzati sono polimeri, sia sintetici che naturali, ceramiche e metalli. Ognuno di essi possiede delle particolari proprietà e viene scelto in base al tipo di oggetto da realizzare.

Ciò che ha determinato il successo di questa tecnica di stampa è la possibilità di ottenere un dispositivo individuale e personalizzato che si adatti e che tenga conto di tutte le variabili fisiologiche e patologiche di ogni paziente. Il tutto rientra nell’ambito di una medicina e soprattutto di una chirurgia, non più vista come prettamente demolitiva e di rimozione, ma ricostruttiva e rigenerativa. Sempre più personalizzata e volta a considerare e rispettare l’individuo nella sua unicità.

Fonti | Review 3D printing, Articolo NEJM su TBM

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