3D打印多孔结构超短柄假体治疗股骨干极限瘤性骨缺损的早期疗效评估  

Short-term outcomes of reconstruction of tumorous critical bone defects at femoral shaft with a 3D printed ultra-short stem with a porous structure

作　　者：杜贵锋 王杰[1] 虎鑫 文阳 谭淋云 卢敏勋 张瑀琦 周勇[1] 罗翼[1] 闵理[1] 屠重棋[1] Du Guifeng;Wang Jie;Hu Xin;Wen Yang;Tan Linyun;Lu Minxun;Zhang Yuqi;Zhou Yong;Luo Yi;Min Li;Tu Chongqi(Department of Orthopaedics,Institute of Orthopaedics,West China Hospital,Sichuan University,Chengdu 610041,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：《中华创伤骨科杂志》2022年第9期805-811,共7页Chinese Journal of Orthopaedic Trauma

基　　金：成都市科技局技术创新项目(2017-CY02-00032-GX);四川大学青岛研究院"8122计划"基金(20GZ30301)。

摘　　要：目的:探讨3D打印多孔结构超短柄假体治疗股骨干极限瘤性骨缺损的早期疗效。方法:回顾性分析2016年9月至2018年6月期间四川大学华西医院骨科收治的8例股骨干恶性肿瘤患者资料。男4例,女4例;平均年龄为36.9岁(11~61岁);术前Enneking分期均为Ⅱb期;骨肿瘤类型:骨肉瘤3例,尤文肉瘤2例,软骨肉瘤2例,骨膜骨肉瘤1例。术前利用CT/MRI图像融合技术明确手术边界、设计导板和假体,并进行手术模拟。8例患者均在肿瘤切除术后接受3D打印多孔结构超短柄重建术。利用断层融合成像技术评估骨整合情况,记录患者的并发症发生情况和骨肿瘤学预后。采用1993年美国骨肿瘤协会(MSTS)下肢功能评分系统和膝关节活动范围评定患者下肢功能恢复情况。结果:8例患者术后获36~50个月(平均42.8个月)随访。1例患者术中发生假体周围骨折,使用钢丝线固定,末次随访时骨折获愈合。随访期间无一例患者肿瘤局部复发、肺部转移及死亡。末次随访时8例患者均获良好骨整合,下肢基本等长。随访期间未出现假体无菌性松动、深部感染及假体骨折等并发症。末次随访时8例患者膝关节屈曲活动度为(116.2°±9.1°),较术前(98.8°±10.9°)显著改善;MSTS下肢功能评分为(26.2±2.1)分,较术前[(21.6±1.8)分]显著改善,差异均有统计学意义(P<0.05)。结论:3D打印多孔结构超短柄假体重建术是股骨干瘤性骨缺损的精准重建方式,通过精细的术前设计、术中操作及术后严格的随访管理,可以取得良好的早期疗效。Objective To explore the short-term outcomes of reconstruction of tumorous critical bone defects at femoral shaft with a 3D printed ultra-short stem with a porous structure.Methods From September 2016 to June 2018,8 patients underwent reconstruction of critical bone defects with a 3D printed ultra-short stem with a porous structure after resection of femoral shaft malignant tumor at Department of Orthopaedics,West China Hospital.There were 4 males and 4 females,with an average age of 36.9 years(from 11 to 61 years).Their preoperative Enneking staging was stageⅡb in all.There were 3 osteosarcomas,2 Ewing sarcomas,2 chondrosarcomas and one periosteal osteosarcoma.Preoperative CT/MRI image fusion technology was used to define the surgical boundary,design the guide plate and prosthesis,and perform surgical simulation.Tomosynthesis-shimadzu Metal Artefact Reduction technology was used to evaluate osseointegration.Complications and bone oncology prognosis of the patients were documented.The lower limb function of the patients was evaluated using Musculoskeletal Tumor Society(MSTS)1993 scoring and knee range of motion.Results The overall follow-up time ranged from 36 to 50 months,averaging 42.8 months.During operation one patient sustained a periprosthesis fracture,the union of which was followed up after wire assisted fixation.There was no local tumor recurrence,lung metastasis or death.The last follow-up revealed good osseointegration and basically isometric lower extremities in all cases.There was no such a complication as aseptic loosening of the prosthesis,deep infection or prosthesis fracture during the follow-up period.At the last follow-up in the 8 patients,the flexion range of the knee joint was 116.2°±9.1°,significantly improved compared with that before operation(98.8°±10.9°),and the MSTS score was(26.2±2.1)points,also significantly improved compared with that before operation[(21.6±1.8)points](P<0.05).Conclusions Reconstruction with a 3D printed ultra-short stem with a porous structure is an accura

关 键 词：假体和植入物 股骨肿瘤 骨缺损 3D打印技术 多孔结构 

分 类 号：R687.3[医药卫生—骨科学]