摘要
目的阐述3D打印定制一体化半骨盆假体的设计理念和手术技巧,评价并讨论该假体治疗髋臼周围原发恶性骨肿瘤的短期疗效。方法收集2016年10月至2017年5月,我中心共11例髋臼周围原发恶性肿瘤接受3D打印定制一体化假体半骨盆置换术患者资料。男5例,女6例,平均年龄45.6岁,其中累及骨盆Ⅰ、Ⅱ区3例,累及骨盆Ⅰ、Ⅱ、Ⅲ区8例;EnnekingⅡb级8例,EnnekingⅢ级3例;软骨肉瘤6例,骨肉瘤1例,去分化皮质旁骨肉瘤1例,尤文氏肉瘤1例,血管肉瘤1例;3例术前诊断为肺部转移。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11个3D打印定制一体化半骨盆假体。其中,8例骶髂关节无法保留,3例骶髂关节保留,8例耻骨上支部分保留,3例耻骨上支完整保留。术后3天内,通过2项髋臼周围肌力及稳定性测试结果进行功能锻炼。以HHS评分系统与MSTS评分系统进行评估,并记录肿瘤学预后与并发症。以X线评估双下肢长度、髋臼偏心距、髋臼前倾角、髋臼外展角。结果术中所有患者获得R0切除及按计划重建。9例臀中肌获得重建,2例无法重建。臀大肌,髂腰肌,缝匠肌及股直肌均良好重建。平均手术时间287.27 min,术中出血量3527.27 ml。平均随访27.82个月。无肿瘤复发及死亡。术前肺转移患者中,1例肺部转移瘤术后病情稳定;1例化疗加靶向治疗后病情稳定;1例未接受治疗肺转移进展。末次随访时,所有病例均获得良好骨整合,所有患者双下肢长度、髋臼偏心距、髋臼前倾角、髋臼外展角与术前相同。其中9例患者无辅助行走,2例患者扶手杖行走。术后MSTS评分、HHS评分与术前比较差异有统计学意义(P <0.001)。1例脂肪坏死引起伤口延迟愈合,经治疗后伤口愈合。无深部感染、假体脱位、假体或螺钉断裂等其它并发症。结论 3D打印定制一体化半骨盆假体治疗髋臼周围原�
Objective To describe the design and surgical skills of 3 D-printed custom-made integrative hemipelvic prosthesis, and to evaluate and discuss the short-term efficacy of the prosthesis in the treatment of periacetabular primary malignant bone tumors. Methods From October 2016 to May 2017, a total of 11 patients with periacetabular primary malignant tumors received 3 D-printed custom-made integrative hemipelvic prosthesis reconstruction in our center. There were 5 males and 6 females with an average age of 45.6 years, including 3 patients with pelvic area Ⅰ and Ⅱ involvement and 8 patients with pelvic area Ⅰ, Ⅱ and Ⅲ involvement. There were 8 Enneking Ⅱb cases and 3 Enneking Ⅲ cases, which included 6 chondrosarcoma, 1 osteosarcoma, 1 dedifferentiated parosteal osteosarcoma, 1 Ewing’s sarcoma, 1 angiosarcoma, and 3 pulmonary metastasis. Preoperative CT/MRI image fusion was used to determine the tumor-free resection margin, design the osteotomy guide and prosthesis, and conduct surgical simulation. A total of 11 3 D-printed custom-made integrated hemipelvic prostheses were designed.Sacroiliac joints of 3 cases were retained, while 8 cases not;superior ramus of the pubis of 3 cases were retained completely, while 8 cases partially. Functional exercise was determined according to the results of 2 periacetabular muscle strength and stability tests within 3 days after the operation. HHS and MSTS scoring systems were used for evaluation, and oncology prognosis and complications were recorded. X-ray was used to evaluate the length of lower limb, acetabular eccentricity, anteversion angle, and abduction angle. Results R0 resection and precise reconstruction were performed in all patients. The gluteus medius muscle was reconstructed in 9 cases, while not in 2 cases. Gluteus maximus, iliopsoas, sartorius and rectus femoris were all well reconstructed. The mean operative time and intraoperative blood loss were 287.27 minutes and 3527.27 ml, respectively. The mean follow-up was 27.82 months. Neither tumor recur
作者
闵理
王杰
张瑀琦
卢敏勋
周勇
张闻力
罗翼
王一天
唐凡
段宏
屠重棋
MIN Li;WANG Jie;ZHANG Yu-qi;LU Min-xun;ZHOU Yong;ZHANG Wen-li;LUO Yi;WANG Yi-tian;TANG Fan;DUAN Hong;TU Chong-qi(Department of Orthopedics,West China Hospital,Sichuan University,Chengdu,Sichuan,610041,China)
出处
《中国骨与关节杂志》
2021年第8期592-600,共9页
Chinese Journal of Bone and Joint
基金
国家重点研究开发项目(2016YFC1102003)
国家重点研究开发项目(2017YFB0702604)
成都市科技局创新项目(2017-CY02-00032-GX)。
关键词
骨盆
假体设计
假体植入
髋臼
骨肿瘤
3D打印
Pelvis
Prosthesis design
Prosthesis implantation
Acetabulum
Bone neoplasms
3D-printed
