3D打印截骨导板与个性化假体在骨肿瘤保膝治疗中的临床应用  

Clinical application of three-dimensional printed osteotomy guide plate and personalized prosthesis in knee-preserving tumor resection

作　　者：刘伟健 王佰川 胡宏志 浦飞飞[1] 刘建湘 吴强[1] 张志才 张英泽 邵增务[1] LIU Weijian;WANG Baichuan;HU Hongzhi;PU Feifei;LIU Jianxiang;WU Qiang;ZHANG Zhicai;ZHANG Yingze;SHAO Zengwu(Department of Orthopedics,Union Hospital Affiliated of Tongji Medical College,Huazhong University of Science and Technology,Wuhan Hubei,430022,P.R.China)

机构地区：[1]华中科技大学同济医学院附属协和医院骨科,武汉430022

出　　处：《中国修复重建外科杂志》2022年第7期811-816,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 探讨在膝关节周围恶性骨肿瘤患者中使用3D打印截骨导板与个性化假体进行保膝治疗的中期疗效。方法 回顾分析2016年9月—2018年10月采用3D打印截骨导板与个性化假体进行保留关节面的肿瘤切除重建术治疗的12例膝关节周围恶性肿瘤患者临床资料。其中男7例,女5例;发病年龄7~59岁,中位年龄44.5岁。骨肉瘤11例、纤维肉瘤1例,均为EnnekingⅡB期。肿瘤与关节面距离为5.5~8.2 cm,平均6.94 cm。术后观察患者切口愈合、肿瘤复发、有无假体周围骨折及无菌性松动等情况,使用美国肌肉骨骼肿瘤学会(MSTS)评分进行功能评价,并测定膝关节屈曲活动度。结果 12例患者均获随访,随访时间41~66个月,平均54.5个月。截骨长度为14~26 cm,平均22.08 cm。除2例患者出现切口浅表感染,未发生累及假体的深部感染,无患者因假体感染行翻修手术。随访期间2例发生局部复发,3例发生远处转移,患者总无病生存率为58.3%。2例患者因肺转移死亡,患者总生存率为83.3%。1例患者因局部复发截肢,1例假体断裂行人工全膝关节置换术翻修;随访期间未发生假体无菌性松动及假体周围骨折,总假体生存率为83.3%。末次随访时10例患者获得了满意膝关节屈曲活动度,达95°~125°,平均110°;2例患儿因疼痛无法配合早期康复治疗,膝关节屈曲活动度恢复不理想,分别为50°和75°。所有患者均获得了可接受的下肢功能,MSTS评分为26~30分,平均28分;患者均可不拄拐独立行走。结论 3D打印截骨导板与个性化假体治疗膝关节周围恶性骨肿瘤,可以保留关节面,患者可获得良好肢体功能,减少假体无菌性松动风险,中期疗效较好。Objective To investigate the mid-term effectiveness of three-dimensional(3D) printed osteotomy guide plate and personalized prosthesis in knee-preserving tumor resection.Methods The clinical data of 12 patients who underwent knee-preserving tumor resection and reconstruction with 3D printed osteotomy guide plate and personalized prosthesis between September 2016 and October 2018 were retrospectively analyzed.There were 7 males and 5 females.The age ranged from 7 to 59 years,with a median of 44.5 years.There were 11 cases of osteosarcoma and1 case of fibrosarcoma,all of which were Enneking grade ⅡB.The distance from the tumor to the joint surface was 5.5-8.2 cm,with an average of 6.94 cm.Incision healing,tumor recurrence,periprosthetic fracture,and aseptic loosening were observed after operation.The Musculoskeletal Tumor Society(MSTS) scoring system was used to evaluate the function of the patients,and the knee flexion range of motion was measured.Results The 12 patients were followed up 41-66months,with an average of 54.5 months.The length of osteotomy ranged from 14 to 26 cm,with an average of 22.08 cm.Except for 2 patients with superficial infection of incision tissue,no deep infection involving the prosthesis occurred,no patient underwent revision surgery because of prosthesis infection.During the follow-up,local recurrence occurred in2 cases and distant metastasis occurred in 3 cases.The overall disease-free survival rate was 58.3%.Two patients died of lung metastasis,and the overall survival rate was 83.3%.One patient underwent amputation due to local recurrence,and1 patient underwent total knee arthroplasty due to prosthesis rupture.No aseptic loosening of the prosthesis and periprosthetic fracture occurred during the follow-up,and the overall prosthesis survival rate was 83.3%.At last follow-up,10 patients obtained satisfactory knee flexion range of motion that ranged from 95° to 125°,with an average of 110°.Two children could not cooperate with early rehabilitation treatment due to pain,and the knee

关 键 词：膝关节周围肿瘤 3D打印技术 截骨导板 个性化假体 保留关节 

分 类 号：R738[医药卫生—肿瘤]