3D打印节段型肿瘤假体重建下肢负重长骨骨肿瘤切除后骨缺损的疗效  

Efficacy of 3D-printed segmental tumor prosthesis for reconstruction of bone defects after resection of weight-bearing long bone tumors in the lower extremity

作　　者：王冀川[1] 梁海杰[1] 赵志庆 杨毅[1] 郭卫[1] 汤小东[1] Wang Jichuan;Liang Haijie;Zhao Zhiqing;Yang Yi;Guo Wei;Tang Xiaodong(Musculoskeletal Tumor Center,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院骨与软组织肿瘤治疗中心,北京100044

出　　处：《中华骨科杂志》2023年第20期1372-1378,共7页Chinese Journal of Orthopaedics

基　　金：北京大学人民医院研究与发展基金 (RDX2022-01,RDE2022-20)。

摘　　要：目的探讨3D打印节段型肿瘤假体重建下肢负重长骨骨肿瘤切除后骨缺损的疗效。方法回顾性分析2015年8月至2021年8月于北京大学人民医院骨与软组织肿瘤治疗中心接受3D打印节段型金属肿瘤假体重建骨缺损的患者71例,男40例、女31例,年龄(23.08±18.52)岁(范围10~63岁)。肿瘤类型:骨肉瘤49例、Ewing肉瘤9例、软骨肉瘤3例、滑膜肉瘤3例、多形性未分化肉瘤2例、横纹肌肉瘤2例、骨转移瘤2例、间叶源性低度恶性肿瘤1例。骨肿瘤Ennecking分期:Ⅲ期19例、Ⅱb期52例。肿瘤位置:股骨43例、胫骨28例。记录手术时间、术中出血量、患者生存率和术后并发症。绘制假体生存率的Kaplan-Meier曲线。假体-自体骨界面骨长入和假体负重能力通过临床表现和影像学检查综合判断。肢体功能评分采用美国肌肉骨骼肿瘤协会(Musculoskeletal Tumor Society,MSTS)93功能评分进行评价。结果71例患者均顺利完成手术并获得随访,随访时间(24.4±13.2)个月(范围6.6~65.4个月)。末次随访时无瘤生存50例、带瘤生存12例、9例因肿瘤进展而死亡。共11例出现假体失效,其中无菌性松动1例、螺钉断裂或假体周围骨折3例、假体周围感染1例、肿瘤进展累及假体6例。Kaplan-Meier曲线显示假体一、三、五年生存率分别为94.2%±2.8%、86.1%±4.7%和79.5%±9.2%。共62例患者获得功能随访,末次随访时MSTS93功能评分为(23.95±5.03)分(范围10~30分),优良率为90%(56/62)。其中股骨假体为(24.63±4.97)分(范围13~30分),胫骨假体为(23.29±5.09)分(范围10~29分)。结论3D打印节段型肿瘤假体重建下肢负重长骨骨肿瘤切除后骨缺损假体生存率高、假体并发症的发生率低、术后功能恢复良好,可作为下肢负重骨骨肿瘤术后重建的一种选择。Objective To investigate the efficacy of 3D-printed segmental tumor prosthesis for reconstruction of bone defects after resection of weight-bearing long bone tumors in the lower extremity.Methods A total of 71 patients who received 3D-printed segmental metal tumor prosthesis for reconstruction of bone defects from August 2015 to August 2021 at the Musculoskeletal Tumor Center of Peking University People's Hospital were retrospectively analyzed.There were 40 males and 31 females,aged 23.08±18.52 years(range,10-63 years).Tumor types:49 cases of osteosarcoma,9 cases of Ewing sarcoma,3 cases of chondrosarcoma,3 cases of synovial sarcoma,2 cases of pleomorphic undifferentiated sarcoma,2 cases of rhabdomyosarcoma,2 cases of bone metastasis,and 1 case of low-grade malignant tumor of mesenchymal origin.Ennecking stage of bone tumor:19 cases of stage III,52 cases of stage IIb.Tumor location:femur 43 cases,tibia 28 cases.Operative time,intraoperative bleeding,patient survival and postoperative complications were recorded.Kaplan-Meier curves for prosthetic survival were plotted.The osseointegration at the prothesis-bone interface was determined by combination of clinical presentation and imaging.Limb function scores were evaluated using the Musculoskeletal Tumor Society(MSTS)93 function score.Results All 71 patients successfully completed the operation and were followed up for 24.4±13.2 months(range,6.6-65.4 months).At the last follow-up,50 patients survived without disease,12 survived with the disease,and the remaining 9 cases died with disease.A total of 11 cases showed prosthesis failure,including 1 case of aseptic loosening,3 cases of screw breakage or periprosthetic fracture,1 case of periprosthetic infection,and 6 cases of tumor progression involving the prosthesis.The Kaplan-Meier curve showed that the 1-year,3-year and 5-year survival rates of prosthesis were 94.2%±2.8%,86.1%±4.7%and 79.5%±9.2%,respectively.62 patients received functional follow-up,and the MSTS93 functional score at the last follow-up was 23.95

关 键 词：骨肿瘤 下肢 打印 三维 假体植入 

分 类 号：R738.1[医药卫生—肿瘤]