3D打印膝关节组配式假体在股骨远端恶性肿瘤保肢手术中的应用  

Application of 3D printed knee joint modular prosthesis in limb salvage operation for malignant tumor of distal femur

作　　者：王顺利[1] 史迎宾[1] 喻斌 张林锋[1] 赵晓博 杨延良[1] 辛晓林[1] 娄高杰 王爱国[1] WANG Shunli;SHI Yingbin;YU Bin;ZHANG Linfeng;ZHAO Xiaobo;YANG Yanliang;XIN Xiaolin;LOU Gaojie;WANG Aiguo(Department of Bone Tumor,Zhengzhou Orthopaedic Hospital,Zhengzhou,Henan 450000,China)

机构地区：[1]郑州市骨科医院骨肿瘤科,450000

出　　处：《中国骨科临床与基础研究杂志》2019年第6期331-336,共6页Chinese Orthopaedic Journal of Clinical and Basic Research

基　　金：河南省科技攻关计划项目(172102310480)。

摘　　要：目的探讨3D打印膝关节组配式人工假体在股骨远端恶性肿瘤患者保肢治疗中的应用效果。方法回顾性分析2016年5月至2019年4月收治的20例股骨远端骨原发恶性肿瘤患者的临床资料,患者均行肿瘤切除膝关节置换术,术中运用3D打印膝关节组配式人工假体。术前CT引导下活检示骨肉瘤8例、尤文肉瘤4例、恶性纤维组织细胞瘤4例、软骨肉瘤3例,余1例为股骨远端骨肉瘤术后假体无菌性松动。Enneking肿瘤分级:Ⅰa级1例、Ⅰb级2例、Ⅱa级6例、Ⅱb级10例。17例于术前接受新辅助化疗(2例软骨肉瘤和1例术后假体松动病例除外)。结果1例患者因肿瘤局部复发失访,余19例随访期间无死亡,其中带瘤生存3例。平均随访时间为1.6年(0.6~2.4年)。末次随访时根据Enneking标准评价肢体功能,优11例、良3例、中4例、差1例,优良率14/19。术后影像学检查结果提示,所有患者自体骨板与3D打印袖套及股骨残端固定良好,愈合满意,骨水泥-假体界面与假体-骨界面均无进行性透亮影出现。结论保肢手术是治疗股骨远端恶性骨肿瘤的有效方式,应用3D打印膝关节组配式假体后自体骨可与3D打印袖套和股骨残端发生骨整合,重建后膝关节功能良好,短期疗效能够满足患者及骨肿瘤专科医生的功能期望,中远期疗效有待进一步随访观察。Objective To investigate the effect of limb salvage surgery using 3 D printed knee joint modular prosthesis in patients with distal femoral malignant tumor.Methods Clinical data of 20 patients with distal femoral primary malignant tumor treated from May 2016 to April 2019 in Zhengzhou Orthopaedic Hospital were retrospectively analyzed.All patients underwent tumor resection and knee arthroplasty with 3 D printed knee joint modular prosthesis.Preoperative CT-guided biopsy showed that there were 8 cases of osteosarcoma,4 of Ewing’s sarcoma,4 of malignant fibrous histiocytoma and 3 of chondrosarcoma,the rest 1 case was diagnosed as prosthetic aseptic loosening after the surgery for distal femoral osteosarcoma.According to Enneking tumor classification,there were 1 case ofⅠa grade,2 ofⅠb grade,6 ofⅡa grade and 10 cases ofⅡb grade.Except for 2 patients of chondrosarcoma and 1 patient of postoperative prosthetic aseptic loosening,17 patients underwent preoperative neoadjuvant chemotherapy.Results Among 20 patients,1 patient lost the follow-up due to local recurrence of tumor,and the rest patients did not die during the follow-up period,with 3 of them survived with tumor.The average follow-up time was 1.6 years(range,0.6 to 2.4 years).According to the evaluation of postoperative limb function by Enneking’s criteria,11 cases were excellent,3 were good,4 were moderate and 1 case was poor,with the excellent and good rate of 14/19 at the latest follow-up.Postoperative imaging results showed that the autogenous bone plate,3 D printed sleeves and femur stump were all fixed and healed well.There was no continuous transparency between the cement-prosthesis and the prosthesis-bone interfaces.Conclusions Limb salvage surgery is an effective method for malignant bone tumors in the distal femur.After the application of 3 D printed knee joint modular prosthesis,autologous bone could be integrated with 3 D printed cuff and femoral stump,and the reconstructed knee joint has good reserved function.In terms of short-term effi

关 键 词：股骨肿瘤 人工膝关节 关节成形术 置换 膝 3D打印 骨移植 移植 自体 骨整合 

分 类 号：R687.42[医药卫生—骨科学] R738[医药卫生—外科学]