基于三维多模态影像的3D打印技术辅助肢体恶性骨肿瘤手术研究  

Research on three-dimensional printing technology based on three-dimensional multimodality imaging to assist the operation of malignant bone tumors of limbs

作　　者：方向 雷森林 罗翼[1] 周勇[1] 闵理[1] 张闻力[1] 屠重棋[1] 段宏[1] FANG Xiang;LEI Senlin;LUO Yi;ZHOU Yong;MIN Li;ZHANG Wenli;TU Chongqi;DUAN Hong(Department of Orthopedics,Orthopedic Research Institute,West China Hospital,Sichuan University,Chengdu Sichuan,610041,P.R.China)

机构地区：[1]四川大学华西医院骨科骨科研究所,成都610041

出　　处：《中国修复重建外科杂志》2022年第7期804-810,共7页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 探讨基于三维多模态影像的3D打印技术用于肢体恶性骨肿瘤手术的临床疗效。方法 回顾分析2016年1月—2019年1月符合选择标准的15例肢体恶性骨肿瘤患者临床资料。男6例,女9例;年龄17~73岁,中位年龄34岁。骨肉瘤5例,软骨肉瘤3例,尤文肉瘤2例,血管肉瘤1例,造釉细胞瘤1例,转移性癌3例。肿瘤部位:肱骨5例,尺骨2例,股骨3例,胫骨5例。病程2~8个月,中位病程4个月。术前基于三维多模态影像进行术前规划、计算机模拟手术、个性化假体及手术导板设计,3D打印骨肿瘤及重建模型、个性化假体及手术导板,并基于模型进行体外模拟手术。术中行膝关节置换2例,半肩关节置换2例,尺骨近端置换2例,保留关节干假体置换9例。观测肿瘤切除的外科边界、手术时间、术中失血量、手术并发症发生情况以及美国肌肉骨骼肿瘤学会(MSTS)评分、肿瘤局部复发情况。结果 15例患者均按术前规划完成手术,外科边界均获得广泛切除边界。手术时间80~240 min,中位数150 min。术中失血量100~400 mL,中位数200 mL。无术中重要血管、神经损伤导致肢体功能明显受限发生。1例切口浅表感染,经换药后愈合;其余患者切口均Ⅰ期愈合。患者均获随访,随访时间6~48个月,中位数24个月。2例患者因肺转移分别于术后6、24个月死亡。随访期间未出现局部复发,无假体脱位及松动等并发症发生。末次随访时MSTS评分为23~30分,平均25分。结论 基于三维多模态影像的3D打印技术能辅助肢体恶性骨肿瘤的精确切除和重建,从而获得良好肿瘤学及功能预后。Objective To explore the role and effectiveness of three-dimensional(3D) printing technology based on 3D multimodality imaging in surgical treatment of malignant bone tumors of limbs.Methods The clinical data of 15patients with malignant bone tumors of the limbs who met the selection criteria between January 2016 and January 2019were retrospectively analyzed.There were 6 males and 9 females,with a median age of 34 years(range,17-73 years).There were 5 cases of osteosarcoma,3 cases of chondrosarcoma,2 cases of Ewing sarcoma,1 case of hemangiosarcoma,1 case of ameloblastoma,and 3 cases of metastatic carcinoma.The tumors were located in the humerus in 5 cases,ulna in 2 cases,femur in 3 cases,and tibia in 5 cases.The disease duration was 2-8 months(median,4 months).Preoperative 3D multimodality imaging was administered first,based on which computer-assisted preoperative planning was performed,3D printed personalized special instruments and prostheses were designed,and in vitro simulation of surgery was conducted,successively.Two cases underwent knee arthroplasty,2 had semi-shoulder arthroplasty,2 had proximal ulna arthroplasty,and 9 had joint-preserving surgery.Surgical margins,operation time,intraoperative blood loss,surgical complications,Musculoskeletal Tumor Society(MSTS) score,and oncological outcome were collected and analyzed.Results All 15 patients completed the operation according to the preoperative plan,and the surgical margins were all obtained wide resection margins.The operation time was 80-240 minutes,with a median of 150 minutes.The intraoperative blood loss was 100-400 mL,with a median of 200 mL.There was no significant limitation of limb function due to important blood vessels or nerves injury during operation.One case of superficial infection of the incision was cured after dressing change,and the incisions of the other patients healed by first intention.All patients were followed up6-48 months,with a median of 24 months.Two of the patients died of lung metastasis at 6 and 24 months after operation

关 键 词：三维多模态影像 3D打印技术 恶性骨肿瘤 手术规划 

分 类 号：R738.1[医药卫生—肿瘤]