数字化定制个体化钛合金胸骨假体在胸骨肿瘤根治性切除胸壁缺损重建术中的临床应用  

Clinical application of digitally customized and individualized titanium alloy sternal prosthesis in reconstruction of chest wall defect after radical resection of sternum tumor

作　　者：胡海丰[1] 王新[2] 聂志浩 刘高利[1] 张文涵 龙杏林 黄杰[1] 谢颂平[1] Hu Haifeng;Wang Xin;Nie Zhihao;Liu Gaoli;Zhang Wenhan;Long Xinglin;Huang Jie;Xie Songping(Department of Thoracic Surgery,Renmin Hospital of Wuhan University,Wuhan 430060,China;Nanyang Central Hospital,Nanyang 473000,China)

机构地区：[1]武汉大学人民医院胸外科,武汉430060 [2]南阳市中心医院,南阳473000

出　　处：《中华解剖与临床杂志》2023年第4期245-250,共6页Chinese Journal of Anatomy and Clinics

基　　金：湖北省自然科学基金(2021CFB317)。

摘　　要：目的探讨数字化定制的个体化钛合金胸骨假体应用于胸骨肿瘤根治性切除患者胸壁缺损重建的可行性。方法病例系列报告。纳入2020年8月—2021年10月武汉大学人民医院胸外科收治的5例原发性胸骨肿瘤患者的病例资料,均为男性,年龄23~60岁(平均43.5岁),其中胸骨柄肿瘤1例、胸骨体肿瘤4例。基于患者术前胸廓CT扫描数据,采用3D打印技术制作1∶1大小的患者胸骨以及与之连接的部分肋骨、锁骨的三维骨骼及肿瘤模型,同时设计并数字化定制个体化的钛合金胸骨假体;在3D打印模型上模拟肿瘤切除术,再将钛合金假体植入缺损的胸骨模型中进行匹配,模拟假体植入手术。全组均在全身麻醉下行胸骨肿瘤根治性切除术,并植入术前定制的个体化钛合金胸骨假体,完成胸骨缺损的修复;其中1例胸骨柄肿瘤患者,肿瘤切除后使用自体肌腱重建了胸锁关节。观察手术时间、术中出血量、围手术期死亡,术后胸壁稳定性、慢性疼痛、患者生存状态、胸锁关节重建患者的肩关节功能,以及术后胸骨假体移位或断裂、胸腔积液、肺部感染等并发症发生。结果全组5例患者手术过程顺利,围术期无死亡病例,无再次手术病例,手术时间为115~165 min,术中出血量80~260 mL。术后病理诊断:骨巨细胞瘤1例、髓系肉瘤1例、软骨肉瘤2例和孤立性浆细胞瘤1例。全组均无需进行肌皮瓣转移修复胸壁;手术切口均为甲级愈合,无植入物感染;胸壁完整稳定,无胸壁浮动和反常呼吸。有1例术后因胸腔积液延迟拔除胸管。全组术后随访12~24个月,未发生术后植入物断裂、移位,或胸腔积液、肺部感染、慢性疼痛等并发症;其中1例胸锁关节重建患者,术后关节功能无障碍。结论数字化定制的个体化钛合金胸骨假体用于胸骨肿瘤根治性切除后胸壁缺损的重建,手术方案可行,操作简单,术后胸壁稳定性好、并发症少�Objective This study aimed to explore the feasibility of using a digitally customized and individualized titanium alloy sternal prosthesis to reconstruct chest wall defects in patients with radical resection of sternal tumors.Methods A case series study of the relevant case data of five patients with primary sternal tumors,who were admitted to the Thoracic Surgery Department of Renmin Hospital of Wuhan University from August 2020 to October 2021,was conducted.All patients were male,aged 23-60 years(average age of 43.5 years).The cases included manubrium sternal tumor(one case)and mesosternal tumor(four cases).On the basis of the preoperative thoracic CT scan data of patients,3D printing technology was used to construct 1∶1 three-dimensional bone and tumor models of the patients'sternum and part of the ribs and clavicle connected to it.Meanwhile,a personalized titanium alloy sternum prosthesis was designed and digitally customized.Tumor resection was simulated on the 3D printed model.Then,the titanium alloy prosthesis was implanted into the defect sternum model to match,and the prosthesis implantation was simulated.In the whole group,radical resection of sternal tumor was performed under general anesthesia,and the digitally customized and individualized titanium alloy sternal prosthesis was implanted to repair the sternal defect.Autologous tendon was used for reconstructed sternoclavicular articulation in the case of manubrium sternal tumor.Operative time,intraoperative blood loss,perioperative death,postoperative chest wall stability and chronic pain,patients'survival status,shoulder joint function in patients with sternoclavicular joint reconstruction,and postoperative complications such as sternal prosthesis displacement or rupture,pleural effusion,and lung infection were observed.Results The operation of the five cases went smoothly.No perioperative death or unplanned reoperation occurred.The operation time was 115-165 min,and the intraoperative blood loss was 80-260 mL.The postoperative pathological types i

关 键 词：胸外科手术 胸骨肿瘤 胸壁缺损重建 钛合金胸骨假体 3D打印技术 数字化定制 

分 类 号：R738.1[医药卫生—肿瘤]