3D打印半骨盆假体治疗经骶髂关节切除的骨盆恶性肿瘤  

3D printed hemipelvic prosthesis for treatment of pelvic malignant tumors resected via sacroiliac joint

作　　者：黄鑫[1] 曲昊 林秾[1] 潘伟波[1] 严晓波[1] 柳萌[1] 林鹏[1] 李恒元[1] 叶招明[1] Huang Xin;Qu Hao;Lin Nong;Pan Weibo;Yan Xiaobo;Liu Meng;Lin Peng;Li Hengyuan;Ye Zhaoming(Department of Orthopedics,The Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院骨科,杭州310009

出　　处：《中华骨科杂志》2021年第16期1116-1124,共9页Chinese Journal of Orthopaedics

摘　　要：目的分析3D打印半骨盆假体在经骶髂关节切除的骨盆恶性肿瘤重建中的手术技术要点,手术适应证和早期临床疗效。方法回顾性分析2016年1月至2020年3月9例累及骨盆Ⅰ+Ⅱ区或Ⅰ+Ⅱ+Ⅲ区的恶性肿瘤患者经骶髂关节截骨并采用与骶骨耳状面贴合的3D打印半骨盆假体重建,其中男7例,女2例;年龄(51.1±10.5)岁(范围27~66岁)。其中软骨肉瘤5例,多形性未分化肉瘤1例,转移性肾癌2例,转移性原始神经外胚层肿瘤1例。根据肿瘤累及范围行骨盆Ⅰ+Ⅱ区或Ⅰ+Ⅱ+Ⅲ区切除,在Ⅰ区切除时通过骶髂关节面进行截骨,予以3D打印的与骶骨耳状面贴合的半骨盆假体重建。术后通过影像学检查评估骨盆假体的髋臼旋转中心偏移情况;采用国际骨肿瘤协会(Musculoskeletal Tumor Society,MSTS)功能评分进行功能评价;评估患者肿瘤学转归及术后并发症。结果9例患者均顺利完成手术,手术时间(4.5±0.6)h(范围3.5~6 h);术中出血量(1400±520)ml(范围800~3000 ml)。9例中3例行骨盆Ⅰ+Ⅱ区切除重建,4例行骨盆Ⅰ+Ⅱ+Ⅲ区切除重建,2例行骨盆Ⅰ+Ⅱ+Ⅲ区联合股骨近端切除重建。9例均获得随访,随访时间(16.4±9.9)个月(范围6~50个月)。9例患者末次随访时MSTS评分平均20.2分(范围12~26分);术后旋转中心水平方向移位距离(10.67±7.12)mm,垂直方向移位(8.56±4.22)mm。1例转移癌患者术后3月化疗期间发现全身多发转移,术后7个月死亡;1例骨盆转移性肾癌在术后1年半时发生多发转移,靶向药物控制,带瘤存活;其余7例手术部位无复发,未发现远处转移。结论3D打印耳状面贴合的半骨盆假体在重建经骶髂关节截骨的骨盆Ⅰ+Ⅱ区或Ⅰ+Ⅱ+Ⅲ区肿瘤切除后骨缺损具有潜在的优势。其近期疗效较为满意,远期疗效尚有待于进一步观察。Objective To analyze the surgical techniques,surgical indications and early clinical effects of 3D printed hemipelvic prostheses in the reconstruction of pelvic malignant tumors resected by the sacroiliac joint.Methods From January 2016 to March 2020,a retrospective analysis of 9 patients with malignant tumors involving pelvis Ⅰ+Ⅱ or Ⅰ+Ⅱ+Ⅲ region were treated with sacroiliac joint osteotomy and 3D printed pelvic prosthesis reconstruction.There were 7 males and 2 females;their age was 51.1±10.5 years(range 27-66 years).Among them,5 cases were chondrosarcoma,1 case was pleomorphic undifferentiated sarcoma,2 cases were metastatic renal cell carcinoma,and 1 case was metastatic primitive neuroectodermal tumor.Resection of pelvic area Ⅰ+Ⅱ or Ⅰ+Ⅱ+Ⅲ were according to the extent of tumor involvement.During the resection of pelvic Ⅰ region,osteotomy was done through sacroiliac joint surface,and 3D printed hemipelvic prosthesis that fits the sacral auricular surface was used for reconstruction.Postoperative imaging examination was used to evaluate the acetabular rotation center deviation of the pelvic prosthesis;the International Bone Tumor Society(Musculoskeletal Tumor Society,MSTS)function score was used for functional evaluation;the patient's oncology outcome and postoperative complications were evaluated.Results All 9 patients successfully completed the operation.The operation time was 3.5-6 hours,with an average of 4.5 hours.The intraoperative blood loss was 800-3000 ml,with an average of 1400 ml.3 patients underwent resection and reconstruction of pelvis Ⅰ+Ⅱ area,4 patients underwent pelvic resection and reconstruction of Ⅰ+Ⅱ+Ⅲ area,2 patients underwent pelvic Ⅰ+Ⅱ+Ⅲ area combined with proximal femur resection and reconstruction;all patients were followed up.The follow-up time was 6-50 months,with an average of 16 months.At the last follow-up of 9 patients,the MSTS score was 12-26,with an average of 20.2;the postoperative rotation center horizontal displacement distance was 10.67�

关 键 词：盆腔肿瘤 假体和植入物 打印 三维 骶髂关节 截骨术 

分 类 号：R738.1[医药卫生—肿瘤]