摘要
四肢大段骨与关节缺损的传统重建方法包括大段异体骨(关节)移植、瘤段灭活再植复合自体腓骨移植、节段性金属假体置换等,虽然能获得良好的功能状态,但有较高的并发症发生率。近年来,3D打印技术在骨科领域的应用取得了快速的发展。定制化3D打印金属假体因具有适型匹配、多孔金属骨小梁界面和骨整合能力强的特点,越来越多地应用于大段骨与关节缺损的重建。3D打印的中段假体能实现邻近关节的保留、骨缺损的精准匹配、即刻稳定及多孔界面的愈合:对肱骨近端肿瘤患者使用3D打印肩关节融合型假体重建可保留肩关节外形、降低脱位风险并改善肩关节功能;对胫骨远端缺损使用3D打印融合型假体通过踝穴的解剖匹配及界面骨整合可恢复下肢力线、实现踝关节融合;对肘关节周围肿瘤进行瘤段切除后使用3D打印半肘关节假体重建可恢复肘关节功能、降低机械并发症发生率;桡骨远端肿瘤切除后使用3D打印腕关节融合假体重建亦能获得良好的腕关节稳定性和功能。3D打印技术良好地弥补了传统生产工艺及手术技术的缺陷,为四肢大段骨缺损的重建带来了新纪元。
Traditional reconstruction methods of massive osteoarticular defects include large allograft strut or osteoarticular allograft,devitalized tumor bone with fibular autograft,segmental metallic endoprosthesis,and etc.Although these methods can achieve good functional status,the high rates of complications remain as a major concern.In recent years,the 3D printing technology has gained rapid progress in the field of orthopedics.Taking the advantages of conformational fitness,porous metallic trabecular interface and great capacity of osseointegration,the custom-made 3D-printed metallic endoprostheses have been increasingly used for reconstruction for massive osteoarticular defects.The 3D-printed intercalary endoprosthesis can preserve the joints,precisely match the bone defect,achieve immediate stability and bone union at the porous interface.Application of a 3D-printed shoulder arthrodesis endoprosthesis for cases of proximal humeral tumors can maintain the contour of the shoulder,decrease the risk of dislocation and improve the function of the shoulder.Reconstruction of the distal tibial defect with a 3D-printed arthrodesis endoprosthesis is also feasible as it can restore alignment and achieve ankle fusion conveniently by the anatomic contour of the mortise.Segmental resection of a peri-elbow tumor and replacement of a 3D-printed custom-made endoprosthesis with elbow hemiarthroplasty not only restores the function of elbow but also decreases the risk of mechanical complications.Reconstruction of distal radial defect after tumor resection with a 3D-printed arthrodesis prosthesis can achieve a stable wrist and good functional status.The 3D printing technology has compensated for the weakness of traditional manufacture technology and surgical techniques,bringing a new era for reconstruction of massive osteoarticular defects in extremities.
作者
郭卫
佘艳春
梁海杰
GUO Wei;SHE Yanchun;LIANG Haijie(Musculoskeletal Tumor Center,Peking University People's Hospital,Beijing 100044,China)
出处
《中华骨与关节外科杂志》
2022年第12期881-888,共8页
Chinese Journal of Bone and Joint Surgery
关键词
3D打印
假体
四肢
肿瘤
骨缺损
3D Printing
Endoprosthesis
Extremity
Tumor
Bone Defect
