3D打印假体技术治疗四肢骨关节肿瘤  

Three-dimensional printed prostheses for treatment of osteoarticular tumors of limbs

作　　者：程维[1] 白长双 郝立昌 

机构地区：[1]北华大学附属医院骨外科二疗区,吉林132011

出　　处：《中国矫形外科杂志》2017年第9期844-847,共4页Orthopedic Journal of China

摘　　要：[目的]探讨3D打印四肢关节肿瘤假体在四肢大关节肿瘤手术治疗中的新方法。[方法]2014年1月~2016年5月在本院接受治疗的四肢关节骨肿瘤患者共6例,全部患者术前都对兴趣区域行CT扫描(层厚为1.0mm),获得平面图像信息,再通过三维重建,得到DICOM格式数据,将数据导入Mimics 17.0软件中,编辑三维立体模型,在模型上确定截骨部位,并设计与剩余骨组织匹配的内置物假体,包括钛合金假体的孔径、密度及孔隙度,新的韧带附丽点。随访时利用国际骨骼肌肉肿瘤保肢(MSTS)功能评分系统对患者的预后进行评估。[结果]所有患者都获得随访,随访时间4~25个月,平均13.2个月,术后经X线片证实剩余骨组织与肿瘤型假体匹配良好,未见假体松动及骨溶解,未见肿瘤复发及转移,6例患者仍存活,各关节功能恢复良好,最后一次随访时MSTS得分为17~28分,平均25.7分,其中优3例,良2例,可1例,优良率达83.3%。[结论]通过3D打印技术的应用,可确定精确截骨范围,设计个体化关节假体,调整钛合金假体的孔径、密度及孔隙度,在假体上设计个体化韧带附丽点,使之接近正常生理解剖,术后关节功能良好,为治疗四肢关节骨肿瘤提供了一种新的方法。[Objective] To explore the new methods for surgical treatment of major osteoarticular tumor of the limbs by implanting 3D printed tumor prosthesis. [Method] Six patients with bone and joint tumors were treated surgically from January 2010 to March 2016. Two-dimensional images of the region of interest （ROI） were obtained in all of the patients by CT scan （slice thickness：was 1.0mm）, Then, the DICOM formatted data were processed with Mimics 17.0seftware to recon- struct a 3D model. We edited the 3D model to determine the resection area, and designed the 3D printed prosthesis which matched the defected areas perfectly, involving the bore diameter, density and porosity of the titaniumalloy, and new insertion of ligaments as well. The Musculoskeletal Tumor Society （MSTS） scoring system were used to evaluate the recovery of the corresponding functions during the follow-up. [Results] All patients were followed up from 4 months to 25 months with an average of 13.2 months.The postoperative X-ray showed that the 3D printed tumor prosthesis matched with the osteoarticular defect following tumor resection properly. No prosthesis loosening, osteolysis, tumor recurrence and tumor metastasis were noted during the follow-up.All patients were still survived with satisfactory function of the affected limb. The latest MSTS score ranged from 17 to 28 with an average of 25.7. Of them, 3 patients were rated as excellent, 2 good and 1 fair; in other words, the satisfactory results got in 83.3% of the patients. [Conclusion] Using 3D printing technology, we can accurately identify the area of tumor resection, design the customized prosthesis, adjust the bore diameter, density, porosity of the titanium alloy, and individualize insertion of ligaments on the prosthesis to make a implant meeting to the concrete anatomicophysiological demand of each patient, therefore it is a promising new method for treatment of osteoarticular tumors of the extremities.

关 键 词：四肢关节 肿瘤假体 3D打印 临床应用 

分 类 号：R738[医药卫生—肿瘤] TP391.73[医药卫生—临床医学]