3D打印假体重建骨肿瘤术后大段骨缺损  

3D-printed prostheses for large bone defect reconstruction following bone tumor surgery

作　　者：丹尼尔·赛德尔丁 黄晓夏 陈江涛[1] 田征[1] 艾克拜尔·尤努斯[1] Daniyar·Saderden;Huang Xiaoxia;Chen Jiangtao;Tian Zheng;Akbar·Yunus(Department of Bone Tumor Surgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,Xinjiang Uygur Autonomous Region,China;Department of Orthopaedics,Xinjiang Military Region General Hospital,Urumqi 830099,Xinjiang Uygur Autonomous Region,China)

机构地区：[1]新疆医科大学第一附属医院骨肿瘤外科,新疆维吾尔自治区乌鲁木齐市830054 [2]新疆军区总医院骨科,新疆维吾尔自治区乌鲁木齐市830099

出　　处：《中国组织工程研究》2023年第29期4628-4634,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:瘤段切除是治疗骨肿瘤的标准方法之一,然而,肿瘤切除后骨缺损的重建面临诸多挑战,3D打印假体在重建骨肿瘤切除后的骨缺损中逐渐得到重视。目的:探讨3D打印假体在骨肿瘤术后大段骨缺损重建中的可行性,并评估术后疗效。方法:回顾性分析2020年12月至2021年9月在新疆医科大学第一附属医院骨肿瘤外科完成骨肿瘤切除+3D打印假体植入的24例患者的临床资料,其中男19例,女5例;平均年龄为23.8(6-61)岁;股骨远端7例,骨盆5例,胫骨近端4例,股骨中段3例,胫骨远端1例,肱骨近端1例,肱骨中段1例,肩胛骨1例,尺骨1例;其中原发性肿瘤22例(包括骨肉瘤13例、尤文肉瘤4例、骨巨细胞瘤2例、软骨母细胞瘤1例、软骨肉瘤1例、骨母细胞瘤1例),转移癌2例。术前及术后详细记录各项影像学资料,17例术前行新辅助化疗;术前及术后6个月采用肌肉骨骼肿瘤协会评分系统对肢体功能进行评估,以目测类比评分对疼痛进行评估,并记录并发症发生情况。结果与结论:①所有患者均行瘤段切除+3D打印假体置入重建骨缺损,均获得随访,随访时间为6-49个月,截骨长度为(18.2±7.3)cm,术中出血量平均为740(100-3000)mL;②2例患者全身转移死亡,其余22例在随访期间无肺转移、复发,1例患者术后25个月出现无菌性松动;③术后6个月,肌肉骨骼肿瘤协会评分高于术前,目测类比评分低于术前,差异均有显著性意义(P<0.05);④末次随访时22例患者肌肉骨骼肿瘤协会评分均评为优;⑤提示3D打印假体在重建骨肿瘤切除导致的大段骨缺损中是可行的,术后功能良好,并发症少,但是需要长期的随访来证明其远期结果。BACKGROUND:Tumor segment resection is one of the standard methods for the treatment of bone tumors.However,the reconstruction of bone defects after tumor resection faces many challenges.A growing number of researchers are focusing on 3D-printed prostheses for bone defect repair and reconstruction following bone tumor surgery.OBJECTIVE:To explore the feasibility of 3D-printed prostheses in the reconstruction of large bone defect following bone tumor surgery and to evaluate the postoperative outcomes.METHODS:Retrospective analysis of clinical data of 24 patients[19 males and 5 females,age 23.8(6-61)years]who underwent bone tumor resection and 3D-printed prosthesis implantation in the Department of Bone Oncology,the First Affiliated Hospital of Xinjiang Medical University from December 2020 to September 2021 was conducted.There were 7 cases with distal femur tumor,5 with pelvis tumor,4 with proximal tibia tumor,3 with middle femur tumor,1 with distal tibia tumor,1 with proximal humerus tumor,1 with middle humerus tumor,1 with scapula tumor,1 with ulna tumor,and 22 cases with primary tumors(13 osteosarcoma,4 Ewing sarcoma,2 giant cell tumor of bone,1 chondroblastoma,1 chondrosarcoma,and 1 osteoblastoma),2 metastatic carcinoma.Preoperative and postoperative imaging data were recorded and neoadjuvant chemotherapy was administered in 17 cases before surgery.The Musculoskeletal Tumour Society score was used to assess limb function before surgery and 6 months after surgery,and pain was assessed by the Visual Analog Scale,as well as the complications were recorded.RESULTS AND CONCLUSION:(1)All patients undergoing resection of the tumor segment and 3D-printed prosthesis implantation for the reconstruction of the bone defect were followed for 6-49 months,and the results showed that the length of osteotomy was(18.2±7.3)cm and an average intraoperative bleeding volume was 740(100-3000)mL.(2)Two patients died of systemic metastasis,the remaining 22 had no pulmonary metastasis or recurrence during the follow-up period,and 1 pat

关 键 词：骨肿瘤 大段骨缺损 3D打印假体 骨重建 疗效分析 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R681