胫骨下段3D打印踝关节融合型肿瘤假体在骨肉瘤广泛切除术中的应用  

Arthrodesis reconstruction of distal tibia by 3D-printed porous prosthesis after malignant tumor resection

作　　者：牛天立 杨毅[1] 梁海杰[1] 杜志业[1] 臧杰[1] 刘星雨 郭卫[1] Niu Tianli;Yang Yi;Liang Haijie;Du Zhiye;Zang Jie;Liu Xingyu;Guo Wei(Musculoskeletal Tumor Center,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院骨与软组织肿瘤治疗中心,北京100044

出　　处：《中华骨科杂志》2022年第5期272-280,共9页Chinese Journal of Orthopaedics

摘　　要：目的探讨应用胫骨下段3D打印踝关节融合型肿瘤假体重建胫骨下段恶性骨肿瘤切除后骨缺损的安全性和早期临床疗效。方法自行设计胫骨下段3D打印踝关节融合型肿瘤假体,假体远端的组配节段与距骨和腓骨远端接触面为3D打印金属骨小梁界面,通过锥接的组配式节段调节假体长度。2017年12月至2019年12月在肿瘤切除术中应用3D打印踝关节融合型肿瘤假体的胫骨下段骨肉瘤患者8例,男5例、女3例;年龄(16.1±7.4)岁(范围8~29岁)。包括骨母细胞型骨肉瘤7例、毛细血管扩张型骨肉瘤1例,Enneking分期均为ⅡB期。在规范术前化疗后行肿瘤广泛切除术,以3D打印踝关节融合型肿瘤假体重建胫骨下段骨缺损。术后6个月内配戴支具行走,6个月后配戴护踝行走。术后每个月行X线检查评估踝关节融合情况,融合完成后每3个月随访一次直至2年,观察并发症发生情况及肿瘤学预后。采用骨骼肌肉肿瘤协会(Musculoskeletal Tumor Society,MSTS)评分评估术后功能。结果胫骨下段肿瘤均毗邻踝关节,均按照术前计划完成截骨,截骨长度为(16.0±3.1)cm(范围11~20 cm),肿瘤切除获得广泛外科边界。假体近端髓腔固定方式:3D打印金属骨小梁柄1例,自体腓骨移植1例,骨水泥固定6例。手术时间为(128.8±18.9)min(范围110~170 min),术中出血量为(125.0±37.8)ml(范围100~200 ml)。全部病例获得随访,随访时间为(15.6±10.5)个月(范围7~39个月)。假体远端与距骨均完全融合,融合时间为(4.3±0.7)个月(范围3~5个月)。随访期间未见肿瘤复发和转移、无伤口并发症和假体松动,全部患者均无瘤生存。末次随访时MSTS评分为84.2%±3.0%(范围80%~90%)。结论胫骨下段3D打印踝关节融合型肿瘤假体重建胫骨下段恶性骨肿瘤切除后的骨缺损安全、有效,融合率高,术后早期功能满意。Objective To evaluate the safety and short-term clinical postoperative functional outcomes of a novel 3D-printed porous prosthesis of the distal tibia for the bone defect after tumorectomy.Methods From December 2017 to December 2019,a total of eight patients diagnosed with malignant bone tumor of the distal tibia were enrolled in this study.All cases received standard preoperative chemotherapy,after which osteosarcoma resection was performed and ankle arthrodesis was reconstructed using a 3D-printed prosthesis developed by our medical center.The contact surface between the distal part of the prosthesis and the talus is a 3D-printed porous surface,which is conducive to ankle fusion.The length of the prosthesis is adjusted by the conical mounting part of the modular prosthesis.The proximal part of the prosthesis can be fixed either biologically or with bone cement.At postoperative follow-up,the function of the fused ankle was assessed by radiographs and the monthly Musculoskeletal Tumor Society(MSTS)score.Results Of the 8 patients,5 were male and 3 were female,aged 8-29 years(mean 16.1±7.4 years),including 7 osteoblastic osteosarcomas and 1 telangiectatic osteosarcoma.Among the procedures,the mean length of osteotomy was 16 cm(11-20 cm).The method of fixation of the proximal part of the prosthesis included one case with 3D-printing of trabecular metal bone,one case with autogenous fibular graft,and six cases with bone cement.All patients were followed up for 7-39 months(mean 15.6±10.5 months).The distal prosthesis and talus were completely fused in all cases.The mean fusion duration was 4.3±0.7 months.The mean MSTS score was 84.2%±3.0%(mean 80%-90%).No tumor recurrence,wound complications,or prosthesis loosening were observed during the follow-up period.Conclusion The novel 3D-printed distal tibial prosthesis is a safe and effective technique for reconstruction of a massive bone defect after tumorectomy of a malignant bone tumor,with high fusion rate,few complications,and satisfactory postoperative function.

关 键 词：骨肉瘤 胫骨 踝关节 假体设计 骨重建 

分 类 号：R738.1[医药卫生—肿瘤]