3D打印聚醚醚酮假体重建锁骨恶性肿瘤切除后缺损△

3D printed polyetheretherketone prosthesis for defect reconstruction secondary to en bloc resection of clavicular malignant tumor

摘要:

[目的] 介绍 3D 打印聚醚醚酮 （polyetheretherketone, PEEK） 假体重建锁骨肿瘤切除后缺损的手术技术及初步临床效果。[方法]对 5 例锁骨恶性肿瘤患者行“锁骨瘤段切除+3D 打印 PEEK 假体重建术”。其中病灶累及锁骨外侧段 3 例、内侧段 2 例，发生病理性骨折 2 例。参照患者健侧锁骨形态使用计算机建模后，3D 打印制备个性化假体及截骨导板，术中根据肿瘤部位切断胸锁韧带或肩锁韧带，另一侧使用截骨导板辅助截骨，整块切除瘤段。置入 3D 打印制备的个性化假体并使用锁定钢板将保留端的正常锁骨与假体紧密连接固定，使用锚钉重建切断的胸锁韧带或肩锁韧带。[结果]患者均顺利完成手术，无神经、血管损伤等并发症。术后切口均 I 期愈合，无感染者。随访 2~26 个月，术后患者肩外形、功能恢复良好，随访期内未发现局部肿瘤复发，未见明显排斥反应等并发症发生。[结论] 锁骨瘤段切除+3D 打印 PEEK 假体重建术治疗锁骨恶性肿瘤技术可行， 近期疗效满意。

Abstract:

[Objective] To introduce the surgical technique and primary clinical outcomes of 3D printed polyetheretherketone prosthesis for defect reconstruction secondary to en bloc resection of clavicular malignant tumor. [Methods] A total of 5 patients underwent abovementioned surgical treatment for clavicular malignancy. The lesion involved the lateral segment of the clavicle in 3 cases, while the medial segment in 2 cases, with pathological fracture in 2 cases. After computer modeling based on the shape of the clavicle on the healthy side of the patient, personalized prosthesis and osteotomy guide plate were prepared by 3D printing. The sternoclavicular ligament or acromioclavicular ligament was cut off according to the location of the tumor during the operation, and the osteotomy guide was used to assist the osteotomy on the other side to remove the tumor segment en bloc. The personalized prosthesis prepared by 3D printing was implanted, and connected and fixed with the normal clavicle at the reserved end by using locking plates, with reattachment of the sternoclavicular ligament or acromioclavicular ligament by anchor sutures. [Results] All the patients were successfully operated on without nerve, vascular injury and other complications, got incisions healed in stage I without infection. The patients were followed up for 2 to 26 months, had the shape and function of the shoulder recovered well after the operation. No local tumor recurrence was found during the follow-up period, and no obvious rejection and other complications were observed. [Conclusion] The 3D printed polyetheretherketone prosthesis for defect reconstruction secondary to en bloc resection of clavicular malignant tumor is a feasible technique, and achieves satisfactory clinical consequences in short-term.