同种异体骨移植与3D打印定制假体治疗Campanacci Ⅲ级或复发性桡骨远端骨巨细胞瘤的疗效比较  

Comparison of the efficacy of allogeneic bone transplantation versus three-dimensional-printed prosthesis for Campanacci grade Ⅲ or recurrent giant cell tumors in the distal radius

作　　者：孙铭昊 虎鑫 谭淋云 王一天 卢敏勋 周勇[1] 罗翼[1] 屠重棋[1] 闵理[1] SUN Minghao;HU Xin;TAN Linyun;WANG Yitian;LU Minxun;ZHOU Yong;LUO Yi;TU Chongqi;MIN Li(Department of Orthopaedics,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中华骨与关节外科杂志》2024年第8期714-722,共9页Chinese Journal of Bone and Joint Surgery

基　　金：四川省科技计划项目重点研发项目(2022YFG0109)。

摘　　要：目的:探讨同种异体骨移植与3D打印定制假体治疗桡骨远端骨巨细胞瘤(GCTB)的临床疗效。方法:回顾性分析2013年3月至2020年7月四川大学华西医院收治的42例CampanacciⅢ级或复发性桡骨远端GCTB患者的临床资料。接受同种异体骨移植重建术的19例患者作为异体骨移植组,接受3D打印定制假体重建术的23例患者作为定制假体组。记录两组患者术前和末次随访的腕关节活动度、疼痛视觉模拟评分(VAS)、握力、Mayo腕关节功能评分和国际骨与软组织肿瘤协会(MSTS)评分,以及随访期间的腕关节退变情况、并发症发生情况。结果:异体骨移植组患者获得37~120个月随访,平均随访(74.6±29.0)个月;定制假体组患者获得37~88个月随访,平均随访(68.9±17.1)个月。末次随访时,两组患者的腕关节活动度(伸直、屈曲、旋后、旋前)、握力、VAS评分、Mayo腕关节功能评分和MSTS评分均明显优于术前(P均<0.05);末次随访时,定制假体组患者的腕关节活动度(伸直、屈曲)、Mayo腕关节功能评分和MSTS评分均高于异体骨移植组(P均<0.05)。异体骨移植组中发生1例远期感染、1例同种异体骨吸收和4例腕关节半脱位,所有患者均出现腕关节退行性改变,平均时间为(8.8±2.9)个月。定制假体组中发生3例腕关节半脱位、3例DRUJ分离,所有患者均未出现腕关节退行性改变。结论:3D打印假体重建术与同种异体骨移植重建术相比,能更好地保留腕关节的部分功能,在治疗CampanacciⅢ级或复发性桡骨远端GCTB中具有一定优势。Objective:To investigate the clinical efficacy of allogeneic bone transplantation and three-dimensional(3D)-printed prosthesis for the treatment of giant cell tumor bone(GCTB)in the distal radius.Methods:A retrospective analysis was conducted on 42 patients with Campanacci grade Ⅲ or recurrent GCTB in the distal radius treated at West China Hospital of Sichuan University from March 2013 to July 2020.Nineteen patients who underwent allogeneic bone transplantation were included in the allograft group,and 23 patients who underwent 3D-printed prosthesis reconstruction were included in the custom prosthesis group.The wrist range of motion(ROM),visual analogue scale(VAS),grip strength,Mayo wrist function score and Musculoskeletal Tumor Society(MSTS)score were recorded in both groups before surgery and at the final follow-up,as well as wrist degeneration and complications during the follow-up period.Results:The follow-up period for the allograft group ranged from 37 to 120 months,with an average of(74.6±29.0)months;for the prosthesis group,it ranged from 37 to 88 months,with an average of(68.9±17.1)months.At the final follow-up,the ROM(extension,flexion,supination,pronation),grip strength,VAS score,Mayo wrist function score and MSTS score were significantly improved in both groups than those before surgery(all P<0.05).Compared with the allograft group,the prosthesis group demonstrated higher ROM(extension,flexion),Mayo wrist function score and MSTS score at the final follow-up(all P<0.05).The complications in the allograft group included one case of long-term infection,one case of allograft resorption and four cases of wrist subluxation.All patients in this group developed wrist degenerative changes,with an average duration of(8.8±2.9)months.In the prosthesis group,there were three cases of wrist subluxation,three cases of distal radioulnar joint separation,and no cases of wrist degeneration.Conclusions:Compared with allogeneic bone transplantation reconstruction,3D-printed prosthesis reconstruction can better pres

关 键 词：同种异体骨移植 3D打印 假体 骨巨细胞瘤 桡骨远端 

分 类 号：R681[医药卫生—骨科学]