化疗与地舒单抗联合3D打印假体治疗掌骨骨巨细胞瘤并肺转移一例报道并文献复习  

Chemotherapy,denosumab combined with 3D printed prosthesis in the treatment of metacarpal giant cell tumor with lung metastasis:a case report

作　　者：翟凯 于秀淳 鲍哲明 徐明 ZHAI Kai;YU Xiu-chun;BAO Zhe-ming;XU Ming(Orthopedics Department,The 960th Hospital of PLA,Jinan,Shandong,250031,China)

机构地区：[1]中国人民解放军联勤保障部队第九六〇医院骨科,济南250031

出　　处：《中国骨与关节杂志》2024年第11期916-923,共8页Chinese Journal of Bone and Joint

摘　　要：目的应用化疗、地舒单抗联合3D打印假体治疗掌骨骨巨细胞瘤并肺多发转移的可行性研究及早期临床疗效。方法回顾分析我院收治1例女性患者,25岁,因发现左手背渐大性肿物2年余入院,根据影像资料及病理结果,诊断为左手第3掌骨骨巨细胞瘤并肺多发转移。术前给予2个疗程DIA方案化疗联合4次地舒单抗治疗,并在3D打印辅助下设计以近端与骰状骨接触面采用多孔结构,远端掌骨头采用光滑金属面为特点的第3掌骨假体。排除手术禁忌后在全麻下行左手第3掌骨切除+3D打印金属假体置换术。术后随访关节功能,通过X线片观察假体及内固定位置,统计并发症情况,通过胸部CT观察肺部转移灶,并对相关文献进行复习,探讨掌骨骨巨细胞瘤相关治疗策略。结果在化疗及地舒单抗药物治疗后,患者肿瘤边缘出现明显硬化带,体积较前缩小。术中沿安全边界将肿瘤完整切除。按照术前设计完成骰状骨截骨及第3掌骨假体的安装。术后继续行地舒单抗药物治疗,随访17个月未见肿瘤复发,无感染、假体松动等并发症。末次随访时中指屈曲功能稍受限,肺部最大转移灶体积缩小,未见新发转移灶。结论化疗、地舒单抗治疗掌骨骨巨细胞瘤后获得了较为清晰的肿瘤边界,并在3D打印辅助下设计的全掌骨假体修复了瘤性骨缺损,早期临床疗效满意,此方案为治疗掌骨骨巨细胞瘤提供了一种切实可行的治疗策略。Objective To study the feasibility and early clinical efficacy of chemotherapy,denosumab combined with 3D printed prosthesis to treat giant cell tumor of metacarpal bone with multiple lung metastases.Methods A retrospective analysis of a 25-year-old female patient admitted to our hospital due to the discovery of a growing mass on the back of her left hand more than 2 years ago was made.Based on the imaging data and pathological results,she was diagnosed as giant cell tumor of the third metacarpal bone of the left hand with multiple lung metastases.Before surgery,2 courses of DIA regimen chemotherapy combined with 4 treatment of denosumab were given.With the assistance of 3D printing,the prosthesis was designed with a porous structure on the contact surface between the proximal end and the capitate bone and a smooth metal surface on the distal metacarpal head.After excluding surgical contraindications,the left third metacarpal bone resection+3D printing metal prosthesis replacement was performed under general anesthesia.The joint function was followed up after surgery.The position of the prosthesis and internal fixation were observed through X-rays.Complications were recorded,and pulmonary metastases were observed through chest CT.Relevant literature was reviewed and relevant treatment strategies for giant cell tumor of the metacarpal bone were discussed.Results After chemotherapy and denosumab treatment,an obvious sclerosis zone appeared at the edge of the tumor,and the volume was smaller than before.During the operation,the tumor was completely resected along the safe margin.The capitate osteotomy and the installation of metacarpal prosthesis were completed according to the preoperative design.After surgery,denosumab treatment was continued,and the follow-up time was 17 months.There was no tumor recurrence,infection,prosthesis loosening or other complications.At the last follow-up,the flexion of the middle finger was slightly limited and the size of the largest lung metastasis was reduced.No new metastasis was f

关 键 词：骨巨细胞瘤 掌骨 放化疗 辅助 打印 三维 地舒单抗 

分 类 号：R738.1[医药卫生—肿瘤]