摘要
目的观察3D打印定制半骨盆假体治疗耻骨原发恶性骨肿瘤的短期疗效。方法回顾性研究2017年6月至2019年5月四川大学华西医院骨科接受了Ⅲ区半骨盆切除联合3D打印定制半骨盆假体置换术治疗的5例耻骨原发恶性骨肿瘤患者资料。男3例,女2例;年龄26~46岁,平均36.3岁;耻骨上支切除3例,全耻骨切除2例;所有患者均为软骨肉瘤;Enneking分期:Ⅱa期1例,Ⅱb期4例。术前利用CT/MRI图像融合技术确定手术边界、设计导板及假体、进行手术模拟。共设计5个3D打印定制半骨盆假体,其中3例为保留部分耻骨的髓内柄固定式假体,2例为不保留耻骨的非髓内柄固定式假体。术后通过国际肌肉骨骼肿瘤(MSTS)评分系统进行功能评估,通过影像学检查进行假体植入位置及假体与宿主骨界面整合情况评估,并记录患者肿瘤学预后及并发症。结果术中所有患者均获得R0切除并按计划重建。术中失血量300~3700 mL,平均为1680 mL;手术时间180~430 min,平均为294 min。随访时间13~29个月,平均20.6个月。所有患者均获无疾病证据存活,无肿瘤复发。末次随访时MSTS评分为29~31分,平均29.8分。其中1例男性患者主诉阴茎勃起功能障碍。3例患者出现髓内柄周围微动磨损,2例患者出现正常耻骨面骨磨损。所有患者均获得良好骨整合,无深部感染、假体脱位、假体或螺钉断裂等其他并发症发生。结论3D打印定制半骨盆假体治疗耻骨原发恶性骨肿瘤早期疗效显著,是骨盆恶性肿瘤重建的可靠方式。
Objective To observe the short-term efficacy of 3D-printed custom-made hemipelvic prosthesis in the treatment of primary malignant bone tumors of the pubis.Methods From June 2017 to May 2019,a total of 5 patients with pubic primary malignant tumor received typeⅢhemipelvectomy and reconstruction with a 3D-printed custom-made hemipelvic prosthesis at Department of Orthopedics,West China Hospital.They were 3 males and 2 females with an average age of 36.3 years(range,from 26 to 46 years).Of them,3 underwent resection of the upper pubic ramus and 2 resection of both pubic rami.All their tumors were chondrosarcomas,with one case of Enneking stageⅡa and 4 cases of Enneking stageⅡb.Preoperative CT/MRI image fusion was used to determine the tumor-free resection margin,design guide templates for osteotomy and prosthesis,and simulate surgical procedures.A total of 53D-printed custom-made hemipelvic prostheses were designed,including 3 ones with an intramedullary stem to preserve partial pubis and 2 ones with a non-intramedullary stem not to preserve the pubis.The functional recovery was assessed by Musculoskeletal Tumor Society(MSTS)scores.The prosthetic position and osseointegration were evaluated by imaging examination.Oncological outcomes and complications were recorded.Results R0 resection and precise reconstruction were accomplished in all patients.Their intraoperative blood loss ranged from 300 to 3,700 mL(mean,1,680 mL),operation time from 180 to 430 min(mean,294 min),and follow-up time from 13 to 29 months(mean,20.6 months).All the 5 patients were alive with no evidence of disease or tumor recurrence.The functional MSTS scores at the final follow-up ranged from 29 to 31(mean,29.8).One male patient complained of erectile dysfunction.Fretting wear around the prosthetic stem was found in 3 patients while bone wear on the normal pubic side in 2.Osseointegration was observed in all patients with no complications like deep infection,prosthesis dislocation,prosthetic or screw breakage.Conclusion Since 3D-printed custom-made hemipelvic prostheses can result in fine short-term efficacy for pubic primary malignant bone tumors,they may be a reliable method to reconstruct pelvic malignant tumors.
作者
虎鑫
李鹏程
张瑀琦
闵理
卢敏勋
王杰
王一天
周勇
罗翼
段宏
屠重棋
Hu Xin;Li Pengcheng;Zhang Yuqi;Min Li;Lu Minxun;Wang Jie;Wang Yitian;Zhou Yong;Luo Yi;Duan Hong;Tu Chongqi(Department of Orthopaedics,West China Hospital,Sichuan University,Chengdu 610041,China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2020年第10期848-854,共7页
Chinese Journal of Orthopaedic Trauma
基金
国家重点研究开发项目(2016YFC1102003)
成都市科技局创新项目(2017-CY02-00032-GX)
国家重点研究开发项目(2017YFB0702604)。
关键词
骨盆
肿瘤
假体设计
3D打印技术
切除术
Pelvis
Neoplasms
Prosthesis design
3D printing technology
Excision
