摘要
恶性原发性骨肿瘤好发于儿童和青少年,以骨肉瘤最常见,主要侵及邻近关节部位[1]。传统常常采用截肢手术治疗骨恶性肿瘤,虽然较彻底的清除了肿瘤原发病灶,但生存率较保肢手术相比并无明显差异[2]。保肢治疗已成为目前治疗骨恶性肿瘤的常用手段。保肢治疗过程中的重点之一在于肿瘤切除后骨缺损的重建,尤以下肢长节段骨缺损的重建十分困难。目前常见的重建方法包括:大段异体骨移植,瘤骨灭活再植,自体腓骨移植,传统假体置换等。
Objective To evaluate 3D printing combined with assembled prosthesis in the treatment oflong-segment bone defect in children.Methods One child with femur osteosarcoma was scanned by thin layer CT,and the three-dimensional bone reconstruction model was made by Mimics14.0 software.The interface between the two ends of the prosthesis and the residual bone was designed as a 3D printed bone trabecular structure,which was beneficial for the growth of residual bone tissue into the prosthesis to achieve biotic and abiotic composite fixation.Furthermore,traditional machined composite prosthesis framed in the middle part could be replaced when the limbs were not equal in length in the future.Individualized plate and screw fixation were also designed at the distal end of the prosthesis to keep early stability.During operation,osteotomy was performed at the distance of three centimeters from the tumor boundary based on MRI examination.Kirschner wire was used to determine the osteotomy plane,and the prosthesis was conjuncted with residual bone.Results X-ray examination showed that the prosthesis waswell-fixed without loosening,fracture or infection one year after operation,and both lower extremities were equal in length.No local recurrence was found in CT and MRI of the primary site of tumor,and no metastatic focus was found in chest CT.The range of motion of the hip joint and knee joint of the affected limb was basically normal,and the MSTS score was 29.Conclusions 3D printed bone ingrowth combined with matching prosthesis preserves both epiphyses in the treatment of long segmental tumor bone defect of lower extremities in children,which can not only achieve good fixation between prosthesis and residual bone,but also reserve the development space for children by retaining both ends of epiphysis.
作者
杨贵
田征
艾克拜尔·尤努斯
陈江涛
徐磊磊
YANG Gui;TIAN Zheng;Akbar·Yunus;CHEN Jiang-tao;XU Lei-lei(Department of Bone Tumors,The First Affiliated Hospital of Xinjiang Medical University,Xinjiang,830000,China)
出处
《中国骨与关节杂志》
CAS
2021年第11期877-880,共4页
Chinese Journal of Bone and Joint
关键词
打印
三维
假体设计
骨肿瘤
骨缺损
保肢术
Printing,three-dimensional
Prosthesis design
Bone neoplasms
Bone defect
Limb salvage
