四肢恶性肿瘤切除后3D打印假体重建的初步结果  

Preliminary outcomes of 3D printed prosthetic reconstruction after resection of malignant bone neoplasm in the limbs

作　　者：卢新昌[1] 李甲振[1] 张岩[1] 张翼[1] 闻嘉[1] 刘永奎[1] 李哲[1] 金池 LU Xin-chang;LI Jia-zhen;ZHANG Yan;ZHANG Yi;WEN Jia;LIU Yong-kui;LI Zhe;JIN Chi(Department of Orthopedic Surgery,The First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院骨科,河南郑州450052

出　　处：《中国矫形外科杂志》2022年第23期2185-2188,共4页Orthopedic Journal of China

基　　金：河南省重点研发与推广专项科技攻关项目(编号:212102310628)。

摘　　要：[目的]探讨四肢原发恶性骨肿瘤切除后3D打印定制假体在重建骨缺损中的设计及临床效果。[方法]回顾性分析本院2018年6月—2020年12月采用3D打印假体手术保肢治疗14例四肢原发恶性骨肿瘤患者的临床资料,病变均位于长骨骨干;其中骨肉瘤10例,尤文肉瘤2例,未分化多形性肉瘤2例,Enneking分期均为IIB期。[结果]患者均顺利完成手术,均未发生围手术期死亡。手术时间平均(162.33±72.06)min,术中出血量平均(1521.42ml±638.42)ml,切口长度平均(20.50±5.69)cm,切口愈合时间平均(14.00±2.44)d,住院时间平均(19.00±2.10)d。所有患者随访(23.70±16.92)个月。与术后3个月相比,术后6个月和末次随访时,VAS评分显著降低(P<0.05)。随术后时间推移,肢体功能MSTS93系统评分无显著变化(P>0.05),患者生存状态的差异无统计学意义(P>0.05)。随访中5例出现肺转移,其中,3例死于多发转移,2例带瘤生存,占35.71%;另外9例无瘤生存,占64.29%。[结论]3D打印假体可以给长骨骨干肿瘤保肢提供一个较好的选择。[Objective]To explore the design and surgical outcomes of 3D printed prosthetic reconstruction after en bloc resection of primary malignant bone tumor in the extremities.[Methods]A total of 14 patients received en bloc resection and 3D printed prosthetic reconstruction of primary malignant long bone tumors on the shaft,including 10 cases of osteosarcoma,2 cases of Ewing sarcoma and 2 cases of undifferentiated pleomorphic sarcoma in Enneking stage IIB.[Results]All the patients had the surgical procedures performed successfully without perioperative death,while with the operation time of(162.33±72.06)min,the intraoperative blood loss of(1521.42±638.42)ml,the incision length of(20.50±5.69)cm,the time to take out stitches of(14.00±2.44)days,and the hospital stay of(19.00±2.10)days.All patients were followed up for(23.70±16.92)months an an average.Compared with that 3 months after operation,the VAS score significantly decreased at 6 months after operation and at the last follow-up with statistical significances(P<0.05).However,the MSTS 93 score for limb function and survival states remained unchanged significantly with time of the follow-up(P>0.05).During the follow-up,5 patients had pulmonary metastasis,3 of them died of multiple metastasis and 2 survived with tumor,accounting for 35.71%,whereas the remaining 9 patients survived without tumor,accounting for 64.29%.[Conclusion]This individualized 3D printed prosthetic reconstruction is a sound choice for massive bone defect secondary to en bloc resection of primary malignant bone tumor on the shaft in the extremities.

关 键 词：原发性恶性骨肿瘤 肢体保留 3D打印假体 重建术 

分 类 号：R738.1[医药卫生—肿瘤]