肩胛骨肿瘤切除3D打印聚醚醚酮个性化定制假体重建五例报告  

3D personalized polyetheretherketone prosthesis reconstruction after scapular tumor resection

作　　者：魏星辉 范宏斌[1] 付军[1] 艾克拜尔·尤努斯[2] 刘冬[1] 田征[2] 李小康[1] 王玲[3] 李涤尘[3] 郭征[1] WEI Xing-hui;FAN Hong-bin;FU Jun;Akbar·Yunus;LIU Dong;TIAN Zheng;LI Xiao-kang;WANG Ling;LI Di-chen;GUO Zheng(Department of Orthopaedics,Xijing Hospital,The Fourth Military Medical University,Xi’an,Shaanxi,710032,China)

机构地区：[1]第四军医大学西京医院骨科,西安710032 [2]新疆医科大学第一附属医院骨肿瘤外科,乌鲁木齐830011 [3]西安交通大学机械制造系统工程国家重点实验室,710032

出　　处：《中国骨与关节杂志》2021年第2期122-127,共6页Chinese Journal of Bone and Joint

摘　　要：目的探讨3D打印聚醚醚酮(polyetherether-ketone,PEEK)个性化定制假体在肩胛骨肿瘤切除重建中的应用价值和效果。方法回顾性分析2017年1月至2019年10月,收治的5例肩胛骨肿瘤切除重建患者,其中我院4例,新疆医科大学附属医院1例,男2例,女3例;左侧3例,右侧2例;年龄16~64岁,平均35岁;良性纤维组织细胞瘤1例,尤文肉瘤2例,软骨肉瘤1例,转移瘤1例。术前根据患者健侧薄层CT三维重建,镜像化处理为患侧肩胛骨重建所用数据,设计个性化定制肩胛骨假体。采用PEEK材料进行控性冷沉积3D打印,其中4例患者PEEK中掺杂钡剂形成可显影材料。术中进行肩胛骨肿瘤全肩胛骨整块切除,3D打印个性化定制PEEK肩胛骨假体重建,其中4例同时进行了肱骨头置换。结果 5例患者成功植入3D打印个性化定制PEEK肩胛骨,手术时间90~150 min,平均124 min,术中出血400~1100 ml,平均780 ml。术后X线片及CT扫描观察,见3D打印个性化定制肩胛骨结构清晰(可显影假体),与对侧肩胛骨位置对称,肩关节位置良好,术后肩关节外展支具功能位固定3周开始功能锻炼,未出现假体脱位、感染和伤口不愈合等并发症。随访3~24个月,平均12个月,所有患者未出现肿瘤复发和远隔转移,末次随访时Constant功能评分64~69分,平均66.8分。结论 3D打印PEEK个性化定制肩胛骨假体可较好地恢复肩胛骨的外形和功能,实现复杂不定型骨的精准重建,其远期效果有待进一步评价。Objective To investigate the value and effect of 3D personalized polyetheretherketone (PEEK)prosthesis reconstruction after scapular tumor resection.Methods Five patients with scapular tumor (3 were in the left;2 were in the right) were analyzed retrospectively from January 2017 to October 2019.There were 2 males and 3 females with an average age of 35 years (range:16-64 years),including 1 benign fibrous histiocytoma,2 Ewing sarcoma,1 chondrosarcoma,and 1 metastatic tumor.Prosthesis was designed according to the mirroring image of 3D reconstruction of the normal side.Controlled cold depositing 3D printing was adopted to fabricate customized PEEK prosthesis,of which barium was doped to be developable in 4 cases.Total scapular tumor resection and 3D customized PEEK prosthesis reconstruction were performed,and humeral head replacement was done in 4 cases simultaneously.Results 3D customized PEEK scapular prosthesis was implanted successfully in 5 cases.The operation ranged90-150 min (average:124 min).The intraoperative blood loss ranged 400-1100 ml (average:780 ml).Postoperative X-ray and CT images showed satisfactory anatomical shoulder position and clearly visible developable prosthesis which is symmetrical with the contralateral scapula.Postoperative exercises began 3 weeks after shoulder fixation in functional position with abduction brace,while no complications such as dislocation,infection,and non-healing were observed.All patients were followed up for 3-24 months (average:12 months).There was no recurrence or metastasis during the follow-up.At the last follow-up,the Constant score ranged 64-69 with an average of 66.8.Conclusions 3D individualized PEEK scapular prosthesis can restore the shape and function of the scapula effectively and achieve accurate reconstruction of complex bone structure.However,long-term outcomes need to be further evaluated.

关 键 词：骨肿瘤 3D打印 肩胛骨 聚醚醚酮 

分 类 号：R738.1[医药卫生—肿瘤]