摘要
目的对股骨近段大段瘤性骨缺损的修复重建方式进行综述,探讨其临床应用效果、优缺点及未来研究方向。方法检索中外文数据库,筛选与股骨近段瘤性骨缺损修复重建相关的基础与临床研究文献,按照保髋重建与非保髋重建两大策略进行分类总结与分析。结果保髋重建中,同种异体骨移植和血管化自体骨移植是传统重建方式,但存在骨整合不良、骨吸收等并发症风险;灭活瘤段回植和牵张成骨技术的临床应用受到限制。近年来3D打印技术日益成熟,个性化假体和精准化手术成为发展趋势。非保髋重建主要包括同种异体骨复合人工关节置换和全股骨置换,前者的关键在于提高同种异体骨存活率和骨整合效率,后者需兼顾髋、膝关节稳定性重建。结论股骨近段瘤性骨缺损修复重建方面已取得长足进步,但仍面临诸多挑战。3D打印技术与数字化设计的结合有望实现精准骨缺损修复。未来需借助多学科交叉融合的新理念、新技术、新材料,为患者提供个体化、精准化的整体解决方案,不断提高患者生存质量。
Objective To review the repair and reconstruction methods for large segmental femoral proximal bone defects caused by tumors,and to explore their clinical application effects,advantages,and disadvantages,and future research directions.Methods A comprehensive search of Chinese and foreign databases was conducted to select basic and clinical research literature related to the repair and reconstruction of femoral proximal bone defects caused by tumors.The studies were classified and analyzed based on two main strategies:hip-preserving reconstruction and non-hip-preserving reconstruction.Results In hip-preserving reconstruction,traditional methods such as allograft transplantation and vascularized autograft transplantation are common but have risks of poor bone integration and bone resorption.The clinical application of inactivated tumor segment reimplantation and distraction osteogenesis techniques is limited.In recent years,three-dimensional printing technology has become increasingly mature,with personalized prostheses and precise surgeries becoming development trends.Non-hip-preserving reconstruction primarily includes allograft prosthesis composite and total femoral replacement.The former focuses on improving the survival rate and bone integration efficiency of the allograft,while the latter requires the simultaneous reconstruction of hip and knee joint stability.Conclusion Significant progress has been made in repairing and reconstructing proximal femoral bone defects caused by tumors,but many challenges remain.The integration of three-dimensional printing technology and digital design offers potential for precise bone defect repair.Future efforts should focus on new concepts,technologies,and materials through multidisciplinary approaches to provide personalized and precise solutions,thereby improving patient quality of life.
作者
谭淋云
王一天
虎鑫
何宣虹
杜贵锋
王浩
汤小迪
孙铭昊
屠重棋
闵理
TAN Linyun;WANG Yitian;HU Xin;HE Xuanhong;DU Guifeng;WANG Hao;TANG Xiaodi;SUN Minghao;TU Chongqi;MIN Li(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
2024年第10期1269-1275,共7页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
股骨近段
瘤性骨缺损
保髋重建
Proximal femur
tumor-related bone defect
hip-preserving reconstruction
