3D打印半肘关节型全肱骨假体的设计及功能评估  

Design and function evaluation of 3D-printed hemi-elbow-arthroplastic total humeral prosthesis

作　　者：晏亮 董森[1] 梁海杰[1] 汤小东[1] 燕太强[1] 臧杰[1] 杜志业[1] 郭卫[1] 杨毅[1] Yan Liang;Dong Sen;Liang Haijie;Tang Xiaodong;Yan Taiqiang;Zang Jie;Du Zhiye;Guo Wei;Yang Yi(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：《肿瘤研究与临床》2022年第5期346-351,共6页Cancer Research and Clinic

摘　　要：目的探讨新型3D打印半肘关节仿生型全肱骨假体的设计、手术要点及短期随访结局。方法回顾性分析2018年3月至2020年3月北京大学人民医院行全肱骨切除、3D打印辅助半肘关节型全肱骨假体置换术的8例肱骨恶性肿瘤患者的临床资料。分析其手术情况、肿瘤学预后、假体并发症及功能状态。8例患者中,男性3例,女性5例,年龄5~37岁;骨肉瘤5例,尤文肉瘤2例,软骨肉瘤1例。结果假体生产周期为(9.8±2.7)d,手术时间为(209±23)min,术中出血量为(569±173)ml。术中假体植入顺利,无术中并发症。术后并发症包括1例桡神经麻痹和1例局部复发(行截肢术)。使用LARS人工韧带或疝补片重建肩关节和肘关节周围关节囊及肌腱韧带附着。术后屈肘活动度为(118±15)°(100~140°),伸肘受限度为(11±9)°(0~25°),肩关节外展(28±12)°(15~50°),肩关节前屈(26±9)°(15~40°)。术后美国肌肉骨骼肿瘤学会(MSTS)-93量表功能评分为(24.1±1.5)分。中位随访时间17个月(12~32个月),7例患者无病生存,1例带瘤生存。结论新型3D打印半肘关节型全肱骨假体具有良好的围术期安全性,可有效恢复肘关节功能,解决了全肘关节型假体尺骨髓内柄应力集中的问题,降低了假体的远期磨损率和松动率。Obiective To investigate the design,the key points of surgery and the outcome of short-term follow-up of hemi-elbow-arthroplastic bionic total humeral prosthesis by using 3D-print.Methods The clinical data of 8 patients with humerus malignant tumor who underwent total humerus resection and a 3D-printed auxiliary hemi-elbow-arthroplastic total humeral prosthesis replacement from March 2018 to March 2020 at Peking University People's Hospital were retrospectively analyzed.The operative data,oncological outcome,complication profiles of prosthesis and functional status of all 8 patients were also analyzed.There were 3 males and 5 females with a mean age of 5-37 years.Histological diagnosis included 5 cases of osteosarcoma,2 cases of Ewing's sarcoma and 1 case of chondrosarcoma.Results The time for production of the prosthesis was(9.8±2.7)d,the operation time was(209±23)min and intraoperative hemorrhage was(569±173)ml.All the prostheses were implanted successfully and no patients experienced intraoperative complications.While 2 patients had postoperative complications,1 case of temporary palsy of radial nerve and 1 case of local recurrence.LARS artificial ligament or hernia patch was used to reconstruct joint capsule and tendon-ligament attached around the elbow and shoulder joint.The flexion and extension of the elbow was(118±15)°(100-140°)and(11±9)°(0-25°),and the abduction and anteflexion of the shoulder was(28±12)°(15-50°)and(26±9)°(15-40°),respectively.The postoperative Musculoskeletal Tumor Society(MSTS)-93 scale score was(24.1±1.5)scores.The median follow-up time was 17 months(12-32 months),7 patients had disease-free survival and 1 patient survived with tumor.Conclusions The novel 3D-printed total humeral prosthesis with hemi-elbow-arthroplasty has a good perioperative safety,which is effective in restoring the function of elbow joint,solving the problem of stress concentration of ulnar marrow lever of total elbow joint prosthesis and lowering long-term wear rate and loosening rate of prosthesi

关 键 词：骨肿瘤 3D打印 全肱骨 肘关节 仿生半关节 

分 类 号：R687.3[医药卫生—骨科学]