摘要
目的探讨3D打印定制一体化半骨盆假体置换术治疗EnnekingⅡ+Ⅲ区骨盆恶性肿瘤术中,采用改良Gibson和髂腹股沟联合(modified Gibson combined with modified ilioinguinal,MGMII)入路的手术技巧,评估该手术入路的便利性和准确性,总结早期手术疗效。方法2017年1月—2019年3月,对7例EnnekingⅡ+Ⅲ区骨盆恶性肿瘤患者采用MGMII入路行肿瘤切除+3D打印半骨盆置换术。男6例,女1例;年龄23~68岁,平均43.7岁。软骨肉瘤1例、尤文肉瘤1例、骨肉瘤1例、恶性神经鞘膜瘤1例、转移性肾透明细胞癌2例、转移性肝细胞癌1例。4例原发恶性肿瘤Enneking分期均为ⅡB期。病程6~12个月,平均9.5个月。术前Harris髋关节评分(HHS)为(82.1±1.4)分,美国肌肉骨肿瘤学会(MSTS)评分为(21.4±1.1)分。影像学检查肿瘤大小为5.1~9.1 cm,平均6.9 cm。记录手术时间、术中失血量和术后输血量、并发症发生情况。术后病理检查根据R分类标准确认肿瘤残留情况;影像学复查测量双侧下肢长度及髋臼高度、偏心距、外展角、前倾角,评估骨整合情况;测量双侧外展肌肌力,采用MSTS评分和HHS评分评价关节功能。结果7例手术均顺利完成。手术时间210~360 min,平均280.0 min;术中失血量1300~2500 mL,平均1785.7 mL;术后输血量为0~11 U,平均6.1 U。术后病理检查确认患者在截骨导板辅助下获得R0切除。术后切口均Ⅰ期愈合。患者均获随访,随访时间30~48个月,平均41.3个月。末次随访时,影像学复查示7例均获得良好骨整合;患侧双下肢长度以及髋臼高度、偏心距、外展角、前倾角与健侧比较,差异均无统计学意义(P>0.05),均达到解剖重建要求。术后3个月,患侧与健侧外展肌肌力比值为68.29%±7.41%,术后12个月为89.86%±2.79%,差异有统计学意义(t=8.242,P=0.000)。末次随访时,MSTS评分及HHS评分分别为(27.3±0.8)、(96.6±1.4)分,较术前明显改善(P<0.05)。患者均能无辅助下行走。随�
Objective To explore the surgical skills of modified Gibson combined with modified ilioinguinal(MGMII)approach in the treatment of EnnekingⅡ+Ⅲpelvic malignant tumors in the three-dimensional(3D)printed customized integrated hemipelvic prosthesis,and to evaluate the convenience and accuracy of the surgical approach and the short-term effectiveness.Methods Between January 2017 and March 2019,7 patients with EnnekingⅡ+Ⅲpelvic malignant tumors were treated with tumor resection and 3D printed hemipelvic prosthesis replacement via MGMII approach.There were 6 males and 1 female.The age ranged from 23 to 68 years,with an average of 43.7 years.There was 1 chondrosarcoma,1 Ewing’s sarcoma,1 osteosarcoma,1 malignant Schwannoma,2 metastatic renal clear cell carcinoma,and 1 metastatic hepatocellular carcinoma.The Enneking stage of 4 cases of primary malignant tumor was stageⅡB.The disease duration was 6-12 months,with an average of 9.5 months.The preoperative Harris hip score(HHS)was 82.1±1.4 and the Musculoskeletal Tumor Society(MSTS)score was 21.4±1.1.The tumor size by imaging examination was 5.1-9.1 cm,with an average of 6.9 cm.The operation time,intraoperative blood loss,postoperative blood transfusion volume,and postoperative complications were recorded.Postoperative pathological examination confirmed tumor residue according to R classification criteria.The lower limb length,acetabular height,acetabular eccentricity,abduction angle,and anteversion angle were measured and the bone integration was observed by imaging review.Bilateral abductor muscle strengths were measured,and joint function was evaluated by MSTS score and HHS score.Results All operations were successfully completed.The operation time was 210-360 minutes(mean,280.0 minutes);the intraoperative blood loss was1300-2500 mL(mean,1785.7 mL);the postoperative blood transfusion volume was 0-11 U(mean,6.1 U).Postoperative pathological examination confirmed R0 resection assisted by osteotomy guide plate.All incisions healed by first intention.All patie
作者
闵理
李隆卿
虎鑫
张瑀琦
王杰
卢敏勋
周勇
张闻力
罗翼
唐凡
段宏
屠重棋
MIN Li;LI Longqing;HU Xin;ZHANG Yuqi;WANG Jie;LU Minxun;ZHOU Yong;ZHANG Wenli;LUO Yi;TANG Fan;DUAN Hong;TU Chongqi(Department of Orthopedics,Orthopedic Research Institute,West China Hospital,Sichuan University,Chengdu Sichuan,610041,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2022年第7期796-803,共8页
Chinese Journal of Reparative and Reconstructive Surgery
基金
四川大学青岛研究院“8122计划”基金(20GZ30301)
成都市科技局创新项目(2017-CY02-00032-GX)
中国博士后科学基金资助项目(2021M702342)
中央高校基本科研业务费专项资金资助(2021SCU12010)
四川大学华西医院专职博士后研发基金(20HXBH136)。
关键词
骨盆肿瘤
3D打印假体
Gibson入路
髂腹股沟入路
半骨盆重建
Pelvic tumor
three-dimensional printed prosthesis
Gibson approach
ilioinguinal approach
hemipelvic reconstruction
