[1]黄余森 莫勇新 刘斌 袁振超 谭家昌**.3D打印技术辅助下定制型假体修复重建股骨远端骨缺损[J].中国微创外科杂志,2023,01(12):939-943.
　Huang Yusen,Mo Yongxin,Liu Bin,et al.Application of 3D Printing Technologyassisted Customized Prosthesis for the Reconstruction of Distal Femoral Bone Defects[J].Chinese Journal of Minimally Invasive Surgery,2023,01(12):939-943.
点击复制

3D打印技术辅助下定制型假体修复重建股骨远端骨缺损()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2023年12期
页码:
939-943
栏目:
新技术新方法
出版日期:
2023-12-25

文章信息/Info

Title:
Application of 3D Printing Technologyassisted Customized Prosthesis for the Reconstruction of Distal Femoral Bone Defects
作者:
黄余森 莫勇新 刘斌 袁振超 谭家昌**
(广西医科大学附属肿瘤医院骨软组织外科，南宁530021)
Author(s):
Huang Yusen;  Mo Yongxin;  Liu Bin;  et al.
Department of Bone and Soft Tissue Surgery, Affiliated Cancer Hospital of Guangxi Medical University, Nanning 530021, China
关键词:
股骨; 骨肿瘤; 骨重建; 定制型假体; 3D打印
Keywords:
Femur; Bone tumor; Bone reconstruction; Customized prosthesis; 3D printing
文献标志码:
B
摘要:
目的探讨3D打印技术辅助下保留股骨髁的定制型假体重建股骨远端恶性肿瘤切除后骨缺损的早期临床效果。方法2019年6月～2021年9月我科对12例股骨远端恶性肿瘤术前通过CT、MRI确定病变范围，利用计算机辅助制作截骨导板及保留股骨髁的定制型假体，待假体定制完毕后行肿瘤瘤段切除、保留股骨髁的定制假体重建术。术后采用美国骨骼肌肉肿瘤协会(Musculoskeletal Tumor Society，MSTS)评分评估膝关节功能。结果手术时间180～270 min，平均200 min。术中出血量300～800 ml，平均450 ml。12例随访12～50个月，平均21.9月。2例术后12、16个月因肿瘤肺部转移死亡，1例术后3个月肿瘤肺转移带瘤生存，1例(8.3％)术后1年出现关节假体周围感染。10例影像学示假体及钢板位置良好，无松动及骨吸收征象，股骨近端3D打印项圈固定在位，4例有连续骨痂形成；末次随访患肢功能状态良好，膝关节屈曲105°～135°，平均115°，伸直无受限，MSTS评分22～28分，(24.3±1.8)分。结论3D打印辅助保留股骨髁的定制型假体置换技术在不增加手术创伤及风险的前提下，可以精确切除股骨远端恶性骨肿瘤并进行有效的解剖重建，术后肢体功能改善，并可潜在减少远期并发症的发生。
Abstract:
ObjectiveTo explore the early clinical efficacy of 3D printing technologyassisted customized prosthesis with preservation of femoral condyles for the reconstruction of bone defects after resection of distal femoral malignancies.MethodsFrom June 2019 to September 2021, our department determined the lesion range of 12 cases of malignant tumors in the distal femur through CT and MRI before surgery. We used computeraided production of osteotomy guide plates and customized prostheses that preserved the femoral condyle. After the prostheses were customized, the tumor segment was removed and a reconstruction was performed by using the customized prosthesis with preservation of femoral condyles. The knee function was evaluated by the American Musculoskeletal Tumor Society (MSTS) functional evaluation criteria.ResultsThe operative time was 180-270 min, with a mean of 200 min. The intraoperative bleeding was 300-800 ml, with a mean of 450 ml. A total of 12 cases were followed up for 12-50 months (average,21.9 months).Two patients died of lung metastasis at 12 and 16 months after surgery, one patient survived with lung metastasis at 3 months after surgery, and one patient (8.3%) developed periprosthetic infection at 1 year after surgery. In 10 patients, imaging showed that the prosthesis and plate were in a good position without signs of loosening or bone resorption, the proximal femur was fixed in place with the 3D printed collar, and continuous bone scab formation was found in 4 cases. At the final followup, the functional status of the affected limb was good, with the knee flexion of 105°-135° (mean, 115°) and no limitation of extension. The MSTS score was 22-28 points ［mean, (24.3±1.8)points］.ConclusionApplication of 3D printingassisted customized prosthetic replacement technology with preservation of the femoral condyles allows for precise resection of malignant distal femoral tumors and effective anatomical reconstruction without increasing surgical trauma and risk, significantly improving postoperative limb function and potentially reducing longterm complications.

参考文献/References:

[1]Kakimoto T, Matsumine A, Asanuma K, et al. The clinical outcomes of total femur prosthesis in patients with musculoskeletal tumors. SICOT J,2019,5:23.
[2]郭卫,梁海杰,杨毅,等.仿生肿瘤型膝关节假体重建儿童股骨远端骨肉瘤切除后骨缺损.中华骨科杂志,2021,41(4):201-210.
[3]董扬,阎洪亮,张智长,等.儿童股骨远端骨肉瘤保留骨骺的定制肿瘤型假体重建术.中华骨科杂志,2015,35(2):121-126.
[4]Wong KC, Kumta SM. Jointpreserving tumor resection and reconstruction using imageguided computer navigation. Clin Orthop Relat Res,2013,471(3):762-773.
[5]Enneking WF, Dunham W, Gebhardt MC, et al. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res,1993,(286):241-246.
[6]Mavrogenis AF, CollMesa L, GonzalezGaitan M, et al. Criteria and outcome of limb salvage surgery. J BUON,2011,16(4):617-626.
[7]Traven SA, Brinton DL, Walton ZJ, et al. A propensityscore matched analysis of limb salvage vs amputation for osteosarcoma. J Surg Oncol,2019,120(7):1252-1258.
[8]Zeegen EN, AponteTinao LA, Hornicek FJ, et al. Survivorship analysis of 141 modular metallic endoprostheses at early followup. Clin Orthop Relat Res,2004,(420):239-250.
[9]中华医学会骨科学分会骨肿瘤学组.四肢骨肉瘤保肢治疗指南.中华骨科杂志,2019,39(1):1-9.
[10]Haijie L, Dasen L, Tao J, et al. Implant survival and complication profiles of endoprostheses for treating tumor around the knee in adults: A systematic review of the literature over the past 30 years. J Arthroplasty,2018,33(4):1275-1287.
[11]Balke M, Ahrens H, Streitbürger A, et al. Modular endoprosthetic reconstruction in malignant bone tumors: indications and limits. Recent Results Cancer Res,2009,179:39-50.
[12]Stevenson JD, Wigley C, Burton H, et al. Minimising aseptic loosening in extreme bone resections: custommade tumour endoprostheses with short medullary stems and extracortical plates. Bone Joint J,2017,99-B(12):1689-1695.
[13]Tsuda Y, Fujiwara T, Sree D, et al. Physealpreserving endoprosthetic replacement with short segment fixation in children with bone sarcomas. Bone Joint J,2019,101-B(9):1144-1150.
[14]Cobb JP, Ashwood N, Robbins G, et al. Triplate fixation: a new technique in limbsalvage surgery. J Bone Joint Surg Br,2005,87(4):534-539.
[15]Gupta A, Pollock R, Cannon SR, et al. A kneesparing distal femoral endoprosthesis using hydroxyapatitecoated extracortical plates. Preliminary results. J Bone Joint Surg Br,2006,88(10):1367-1372.
[16]Takeuchi A, Yamamoto N, Hayashi K, et al. Jointpreservation surgery for pediatric osteosarcoma of the knee joint. Cancer Metastasis Rev,2019,38(4):709-722.
[17]Coathup MJ, Batta V, Pollock RC, et al. Longterm survival of cemented distal femoral endoprostheses with a hydroxyapatitecoated collar: a histological study and a radiographic followup. J Bone Joint Surg Am,2013, 95(17):1569-1575.
[18]王顺利,史迎宾,喻斌,等.3D打印膝关节组配式假体在股骨远端恶性肿瘤保肢手术中的应用.中国骨科临床与基础研究杂志,2019,11(6):331-336.
[19]Wu H, Yang S, Liu J, et al.3D printing guide plate for accurate hemicortical bone tumor resection in metaphysis of distal femoral: a technical note. J Orthop Surg Res,2021,16(1):343.

备注/Memo

备注/Memo:
基金项目：广西医疗卫生适宜技术开发与推广应用(S2020098）**通讯作者，Email:gusanqu@126.com
更新日期/Last Update: 2024-04-03