3D打印技术辅助反肩置换在肱骨近段肿瘤切除后肢体重建中的应用  

Three-dimensional printing technology in reverse shoulder arthroplasty after resection of proximal humeral tumors

作　　者：郭宇 冯德宏 王凌 丁育健 刘仪 何俊山 Guo Yu;Feng Dehong;Wang Ling;Ding Yujian;Liu Yi;He Junshan(Department of Joint Surgery,the Affiliated Wuxi People's Hospital of Nanjing Medical University,Wuxi 214023,China)

机构地区：[1]南京医科大学附属无锡人民医院关节外科,无锡214023

出　　处：《中华骨科杂志》2023年第9期559-566,共8页Chinese Journal of Orthopaedics

基　　金：无锡市社会发展科技示范工程(N20192006);江苏省自然科学基金面上项目(BK20181135);无锡市卫生健康委重大项目(Z202010)。

摘　　要：目的探讨3D打印技术辅助反肩关节置换术在肱骨近段肿瘤切除后肢体重建中的应用价值。方法回顾性分析2017年12月至2021年1月在南京医科大学附属无锡人民医院采用3D打印技术辅助反肩关节置换进行肱骨近段肿瘤切除后肢体重建的8例患者资料,男4例、女4例;年龄(55.1±13.0)岁(范围31~73岁);均为单侧发病,左侧2例、右侧6例;平滑肌肉瘤(EnnekingⅡB期)1例、软骨肉瘤2例(EnnekingⅠA期1例、ⅠB期1例)、骨巨细胞瘤4例(Campanacci 3级)、肺腺癌骨转移1例。所有患者术前均使用计算机设计个性化假体和植入方案,采用3D打印技术制造肩胛盂基座;术中行MalawerⅠ型肿瘤切除术和半限制型反肩关节置换,其中6例同时使用同种异体骨复合重建。术后行肩关节X线检查,测量肩关节活动度,采用Constant-Murley功能评分及肌肉骨骼肿瘤协会(Musculoskeletal Tumor Society,MSTS)评分评价肩关节功能。结果8例患者均顺利完成手术,手术时间(173.8±46.7)min(范围130~260 min),术中出血量(487.5±334.6)ml(范围200~1200 ml),肱骨近段切除长度(9.9±4.6)cm(范围4.5~19.0 cm)。所有患者均获得随访,随访时间(45.6±12.5)个月(范围24~60个月)。末次随访时8例患者肩关节主动外展由术前27.5°±14.4°(范围10°~45°)提高至106.3°±21.8°(范围60°~140°),差异有统计学意义(t=11.37,P<0.001);前屈由术前28.1°±12.8°(范围15°~50°)提高至115.6°±24.0°(范围70°~135°),差异有统计学意义(t=11.49,P<0.001);Constant-Murley肩关节功能评分由术前(40.5±14.3)分(范围19~63分)提高至(79.3±11.2)分(范围61~96分),差异有统计学意义(t=9.58,P<0.001);MSTS评分为(25.6±2.2)分(范围23~28分),其中优6例、良2例。1例于术后2周发生关节脱位,经手法复位成功。末次随访时8例患者均存活,无一例发生局部肿瘤复发、转移、假体感染和松动。结论3D打印技术辅助反肩关节置换有助于肱骨近段肿瘤切除后有效�Objective To analyze the efficacy of the reconstruction of the proximal humerus by reverse shoulder arthroplasty with three-dimensional(3D)printing technology after tumor rescetion.Methods A retrospective analysis was conducted on the data of eight patients undergoing semi-constrained reverse shoulder arthroplasty with 3D printing technology after the resection of bone tumors in proximal humeri at the Affiliated Wuxi People's Hospital of Nanjing Medical University from December 2017 to January 2021.There were four males and four females with an average age of 55.1(range,31-73)years,all of whom had unilateral onset,2 on the left and 6 on the right.There was one case of leiomyosarcoma(Enneking IIB),two cases of chondrosarcomas(one Enneking IA and one Enneking IB),four cases of Campanacci grade 3 giant cell tumor of bone,and one case of bone metastasis of lung adenocarcinoma.Individualized prosthesis and implantation protocol were completed preoperatively in all patients.The glenoid baseplate was manufactured using 3D printing technology.During the surgery,Malawer type I tumor resection and semi-constrained reverse shoulder arthroplasty were performed,with 6 cases simultaneously using allograft-prosthetic composite reconstruction.The follow-up was scheduled,and the patient received X-ray examination of the shoulder.The range of motion of the shoulder was measured,the Constant-Murley score and musculoskeletal tumor society(MSTS)score were recorded.Results All 8 patients successfully completed the surgery,with a surgical time of 173.8±46.7 min(range,130-260 min),intraoperative blood loss of 487.5±334.6 ml(range 200-1,200 ml),and proximal humeral resection of 9.9±4.6 cm(range,4.5-19.0 cm).All patients were followed up for a period of 45.6±12.5 months(range,24-60 months).At the last follow-up,the abduction ranges of motion of the affected shoulders increased from 27.5°±14.4°pre-operatively to 106.3°±21.8°post-operatively,with a statistically significant difference(t=11.37,P<0.001).The forward flexion ranges in

关 键 词：骨肿瘤 关节成形术 置换 肩 假体设计 打印 三维 

分 类 号：R738.1[医药卫生—肿瘤]