骨肉瘤切除患者3D打印假体置换保留自体关节重建患肢功能八例报告  

A report of 8 osteosarcoma resection patients with 3D printing prosthesis replacement and preservation of autologous joint for reconstruction of limb function

作　　者：陈国景 李明辉[1] 肖鑫 鲁亚杰 王凤伟 王臻 姬传磊 李靖[1] CHEN Guo-jing;LI Ming-hui;XIAO Xin;LU Ya-jie;WANG Feng-wei;WANG Zhen;JI Chuan-lei;LI Jing(Department of Orthopaedics,Xijing Hospital,The Air Force Military Medical University,Xi’an,Shaanxi,710032,China)

机构地区：[1]中国人民解放军空军军医大学西京医院骨科,西安710032

出　　处：《中国骨与关节杂志》2023年第12期889-895,共7页Chinese Journal of Bone and Joint

摘　　要：目的探讨骨肉瘤切除后使用3D打印假体进行复杂的保留自体关节重建的临床疗效。方法介绍2017年1月至2019年12月,在我院行下肢骨肉瘤者8例行3D打印假体置换者,术前设计、手术步骤及操作要点、术后随访及影像学评估结果。结果8例术后平均随访43.5(36~60)个月。至末次随访,7例存活且无肿瘤局部复发及远隔转移,1例随访36个月,出现肺转移。7例的假体均未出现松动及断裂,随着随访时间的延长,术后即刻假体-骨界面存在的间隙逐渐有新骨组织长入,并向假体边缘延伸包裹假体,形成“焊接式”整合。1例在末次随访时发生假体断裂。患者术后末次随访平均MSTS功能评分为93.81%(91.81%~96.87%)。结论3D打印假体的界面骨整合能力对复杂的保留自体关节面手术临床效果满意,随着其制造和质量规范进一步标准化,可为肢体恶性肿瘤切除后能保留自体关节的患者提供一种新的选择。Objective To explore the clinical effect of complex autologous joint-preserving osteosarcoma resection and reconstruction using 3D-printed prosthesis.Methods A retrospective study was performed on 8 patients with osteosarcoma of the lower extremity in our institution from January 2017 to December 2019.The locations of the osteosarcomas were as follows:two cases in the distal femur,four cases in the distal tibia and four case in the proximal tibia.The 8 included patients ranged in age from 6 to 30 years(mean:11.8 years).The tumor appeared without involvement of the epiphysis and epiphyseal plates.3D printable templates of patients were designed virtually from preoperative thin-layer CT data.The tumor was excised with preservation of the articular surface(≤1 cm in 5 cases)and 3D printed prostheses were used to repair the bone defects.Clinical and radiographic findings were evaluated postoperatively at regular follow-up visits.The stability of the prostheses was analyzed.Limb function was assessed using the Musculoskeletal Tumor Society Scoring system(MSTS).The oncological outcomes and prostheses complications were recorded in detail.Results The mean follow-up time was 43.5 months(36-60 months).7 patients remained alive without tumor recurrence or metastasis at the last follow-up.One patient developed lung metastasis at 36 months.No complications such as prosthesis loosening and breakage were observed in 7 cases.Prosthesis breakage was observed at the last follow-up.Osseointegration was formed in the bone-implant interfaces.Bone ingrowth was found around the bone-implant interfaces and wrapped prosthesis to form“welding”osseointegration with increasing follow-up time.The average functional score according to MSTS score was 93.81%(91.81%-96.87%)at the last follow-up.Conclusions The application of customized 3D printed prosthesis in the revision of complex autologous joint-preserving osteosarcoma resection and reconstruction achieves satisfactory results.With the standardization of the manufacturing and quality

关 键 词：打印 三维 骨肉瘤 假体植入 矫形外科手术 

分 类 号：R687.4[医药卫生—骨科学]