3D打印全肩胛骨反肩关节置换术在肩胛骨肿瘤治疗中的应用研究  

Application of three-dimensional printed total scapula for reverse shoulder arthroplasty in treatment of scapular tumors

作　　者：王战[1,2,3,4,5] 严晓波 林秾[1,2,3,4,5] 黄鑫 柳萌[1,2,3,4,5] 李恒元[1,2,3,4,5] 李冰皓 李秀茅[1,2,3,4,5] 曲昊[1,2,3,4,5] 林鹏 叶招明[1,2,3,4,5] WANG Zhan;YAN Xiaobo;LIN Nong;HUANG Xin;LIU Meng;LI Hengyuan;LI Binghao;LI Xiumao;QU Hao;LIN Peng;YE Zhaoming(Department of Orthopedic Surgery,the Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou Zhejiang,310009,P.R.China;Orthopedics Research Institute of Zhejiang University,Hangzhou Zhejiang,310009,P.R.China;Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province,Hangzhou Zhejiang,310009,P.R.China;Zhejiang Provincial Clinical Medical Research Center for Motor System Diseases,Hangzhou Zhejiang,310009,P.R.China;International Chinese Musculoskeletal Research Society,Hangzhou Zhejiang,310009,P.R.China)

机构地区：[1]浙江大学医学院附属第二医院骨科,杭州310009 [2]浙江大学骨科研究所,杭州310009 [3]浙江省运动系统疾病研究与精准诊治重点实验室,杭州310009 [4]浙江省运动系统疾病临床医学研究中心,杭州310009 [5]国际华人骨研学会联合研究中心,杭州310009

出　　处：《中国修复重建外科杂志》2022年第7期817-821,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(82103499);中国博士后科学基金第69批面上项目(2021M692792);浙江省自然科学基金项目(LQ22H160040、LY19H160045)。

摘　　要：目的 探讨3D打印全肩胛骨反肩关节置换术治疗肩胛骨肿瘤的疗效。方法 2017年11月—2021年12月,采用3D打印全肩胛骨反肩关节置换术治疗5例肩胛骨肿瘤患者。男1例,女4例;年龄44~59岁,平均50.4岁。软骨肉瘤2例,高级别骨肉瘤1例,肺癌肩胛骨转移1例,韧带样纤维瘤病复发1例。病程4~8个月,平均5.8个月。根据美国肌肉骨骼肿瘤学会(MSTS)肩胛带分区标准,4例肿瘤累及S1、S2区,1例累及S2区。肿瘤直径4.2~11.2 cm,平均6.1 cm。记录手术时间、术中出血量及输血情况。随访期间采用MSTS评分评价患者肢体功能恢复情况,观察有无肩部下垂、并发症发生以及肿瘤学结局等,影像学复查假体位置。结果 手术时间155~230 min,平均189 min。术中出血量100~1 500 mL,中位数600 mL;其中2例术中分别输血800、1 850 mL。术后切口均Ⅰ期愈合,无感染等并发症发生。患者均获随访,随访时间4~22个月,平均13个月;其中2例患者因肿瘤全身多处转移和脏器衰竭,分别于术后8、15个月死亡。末次随访时,患者MSTS评分为73%~83%,平均77.4%;患肩较健侧下沉2~4 cm,平均3 cm。影像学复查示随访期间无假体松动、脱位、断裂等并发症发生。结论 3D打印全肩胛骨反肩关节置换术治疗肩胛骨肿瘤可获得良好肩关节功能及外观,患者接受度和满意度较高。Objective To investigate the effectiveness of three-dimensional(3D) printed total scapula for reverse shoulder arthroplasty in the treatment of scapular tumors.Methods Between November 2017 and December 2021,5 patients with scapular tumors were treated by reverse shoulder arthroplasty with 3D printed total scapula.There was1 male and 4 females.The age ranged from 44 to 59 years,with an average of 50.4 years.There were 2 cases of chondrosarcoma,1 case of high-grade osteosarcoma,1 case of lung cancer with scapular metastasis,and 1 case of ligamentoid fibromatosis recurrence.The disease duration was 4-8 months,with an average of 5.8 months.According to the Musculoskeletal Tumor Society(MSTS) scapular girdle classification criteria,4 cases of tumors involved both S1 and S2zones,and 1 case involved S2 zone.The tumor diameters ranged from 4.2 to 11.2 cm,with an average of 6.1 cm.The operation time,intraoperative blood loss,and blood transfusion were recorded.During follow-up,the MSTS score was used to evaluate the recovery of limb function of the patients.The sink depth of the affected shoulder,complications,and oncological outcomes were observed.The position of the prosthesis was reviewed by imaging.Results The operation time ranged from 155 to 230 minutes,with an average of 189 minutes.The intraoperative blood loss was 100-1 500 mL,with a median of 600 mL.Two patients were received blood transfusion of 800 mL and 1 850 mL respectively during operation.All incisions healed by first intention,and no complications such as infection occurred.All patients were followed up 4-22 months,with an average of 13 months.Two patients died at 8 and 15 months after operation respectively due to multiple metastases and organ failure.At last follow-up,the MSTS score of all patients was 73%-83%,with an average of 77.4%.The affected shoulder was 2-4 cm lower than the contralateral side,with an average of 3 cm.Imaging examinations showed that no prosthesis loosening,dislocation,or fracture occurred during follow-up.Conclusion Reverse sho

关 键 词：肩胛骨肿瘤 3D打印假体 保肢术 反肩关节置换术 全肩胛骨切除术 

分 类 号：R738[医药卫生—肿瘤]