3D打印定制股骨髓内柄在肿瘤假体翻修中的应用  

Safety and efficacy of 3D printing personalized intramedullary stem in tumor prosthesis revision

作　　者：郑凯 于秀淳 徐明 崔浩诚 陈倩 侯子伟 Zheng Kai;Yu Xiuchun;Xu Ming;Cui Haocheng;Chen Qian;Hou Ziwei(Department of Orthopaedics,the 960th Hospital of PLA Joint Logistics Support Force,Jinan 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：《中华骨科杂志》2025年第2期102-108,共7页Chinese Journal of Orthopaedics

基　　金：山东省医学会青年人才托举工程项目课题(2023_LC_0077)。

摘　　要：目的探讨3D打印定制股骨髓内柄在肿瘤假体翻修中的应用及临床疗效。方法回顾性分析2021年6月至2023年6月于中国人民解放军联勤保障部队第九六〇医院因股骨侧肿瘤假体髓内柄松动而接受3D打印定制股骨髓内柄翻修的11例患者资料,男7例、女4例,年龄(53.1±11.7)岁(范围38~75岁)。初次手术肿瘤病理类型:骨巨细胞瘤4例,骨肉瘤5例,软骨肉瘤1例,浆细胞瘤1例。肿瘤部位:股骨远端8例,股骨近端3例。翻修次数:初次翻修3例,二次翻修7例,三次翻修1例。肢体短缩(4.6±2.2)cm(范围2.5~9.0 cm)。翻修前所有假体均为骨水泥固定型,均出现股骨髓腔扩大及骨皮质变薄,其中5例髓内柄穿出股骨皮质、1例合并存在股骨劈裂骨折。11例患者均按照个体化数据设计并3D打印加工制作股骨髓内柄。结果3D打印多孔股骨髓内柄的长度为80~160 mm(平均105 mm)、直径20~22 mm。10例患者采用髓内柄圆柱状设计、1例采用圆锥状髓内柄设计;10例患者成功完成3D打印髓内柄翻修、1例3D打印圆锥状髓内柄植入失败,更换为骨水泥假体翻修;3例患者在髓内柄植入时出现了皮质轻微劈裂,术中给予捆扎固定。所有假体均在术中获得即刻稳定,术后患者肢体短缩未明显矫正。所有患者术后切口均正常愈合,肢体疼痛视觉模拟评分从术前的(8.0±0.8)分降低至术后3个月时的(1.0±0.4)分,差异有统计学意义(t=25.957,P<0.001);术后6个月时无一例患者诉肢体疼痛。11例患者均获得随访,随访时间(25.2±7.5)个月(范围16~36个月),患者肢体功能恢复满意。MSTS评分由术前的(7.9±1.4)分升高至末次随访时的(20.9±2.7)分,差异有统计学意义(t=14.229,P<0.001)。影像学评估见下肢力线正常,假体柄无旋转及纵向移位,与股骨整合良好。结论3D打印定制髓内柄可用于股骨肿瘤假体的翻修,术中稳定性好,可获得良好的初步临床疗效。ObjectiveTo investigate the application and clinical efficacy of customized,3D-printed femoral bone marrow stems in the revision of tumor prostheses.MethodsA retrospective analysis was performed for the data of 11 patients(7 males and 4 females)aged 53.1±11.7 years(range,38-75 years),who underwent 3D-printed customized revision of femoral intramedullary stems due to loosening of femoral tumor prostheses at the 960th Hospital of the Joint Support Force of the PLA from June 2021 to June 2023.The pathological types of tumors associated with the initial surgeries included 4 cases of giant cell tumor of bone,5 cases of osteosarcoma,1 case of chondrosarcoma,and 1 case of plasma cell tumor.The tumor was located at the distal femur in 8 cases and the proximal femur in 3 cases.The procedures included 3 initial revisions,7 secondary revisions,and 1 tertiary revision.The average limb shortening measured 4.6±2.2 cm(range,2.5-9.0 cm).Prior to revision,all prostheses were fixed with bone cement,revealing enlargement of the femoral medullary cavity and cortical bone thinning.Among them,5 cases had intramedullary stems permeabilizing the femoral cortex,and 1 case had femoral cleavage fractures.All 11 patients received personalized data for the design and 3D printing of femoral bone marrow stems.ResultsThe lengths and diameters of the 3D-printed porous femoral bone marrow stems ranged from 80 to 160 mm and 20 to 22 mm,respectively.Ten patients were fitted with cylindrical intramedullary handles,while one received a conical intramedullary handle.A successful revision with the 3D-printed stems was achieved in 10 patients;however,1 case failed to accommodate the conical handle and was instead revised with a bone cement prosthesis.During the implantation of the intramedullary stems,three patients experienced minor cortical splitting,which was managed with bundling and fixation during the procedure.Immediate stability was attained for all prostheses during surgery,yet postoperative limb shortening did not undergo significant correct

关 键 词：股骨肿瘤 打印 三维 假体和植入物 再手术 

分 类 号：R738.1[医药卫生—肿瘤]