四肢恶性肿瘤切除后3D打印假体重建的初步结果△

Preliminary outcomes of 3D printed prosthetic reconstruction after resection of malignant bone neoplasm in the limbs

摘要:

[目的]探讨四肢原发恶性骨肿瘤切除后 3D 打印定制假体在重建骨缺损中的设计及临床效果。[方法]回顾性分析本院 2018 年 6 月—2020 年 12 月采用 3D 打印假体手术保肢治疗 14 例四肢原发恶性骨肿瘤患者的临床资料，病变均位于长骨骨干；其中骨肉瘤 10 例，尤文肉瘤 2 例，未分化多形性肉瘤 2 例，Enneking 分期均为 IIB 期。[结果]患者均顺利完成手术， 均未发生围手术期死亡。手术时间平均(162.33±72.06)min，术中出血量平均(1 521.42ml±638.42)ml，切口长度平均(20.50± 5.69)cm，切口愈合时间平均(14.00±2.44)d，住院时间平均(19.00±2.10)d。所有患者随访(23.70±16.92)个月。与术后 3 个月相比，术后 6 个月和末次随访时，VAS 评分显著降低 (P＜0.05)。随术后时间推移，肢体功能 MSTS93 系统评分无显著变化 (P＞0.05)，患者生存状态的差异无统计学意义(P＞0.05)。随访中 5 例出现肺转移，其中，3 例死于多发转移，2 例带瘤生存，占 35.71%；另外 9 例无瘤生存，占 64.29%。[结论]3D 打印假体可以给长骨骨干肿瘤保肢提供一个较好的选择。

Abstract:

[Objective] To explore the design and surgical outcomes of 3D printed prosthetic reconstruction after en bloc resection of pri- mary malignant bone tumor in the extremities. [Methods] A total of 14 patients received en bloc resection and 3D printed prosthetic recon- struction of primary malignant long bone tumors on the shaft, including 10 cases of osteosarcoma, 2 cases of Ewing sarcoma and 2 cases of un- differentiated pleomorphic sarcoma in Enneking stage IIB. [Results] All the patients had the surgical procedures performed successfully without perioperative death, while with the operation time of (162.33±72.06) min, the intraoperative blood loss of (1 521.42±638.42) ml, the incision length of (20.50±5.69) cm, the time to take out stitches of (14.00±2.44) days, and the hospital stay of (19.00±2.10) days. All patients were followed up for (23.70±16.92) months an an average. Compared with that 3 months after operation, the VAS score significantly de- creased at 6 months after operation and at the last follow-up with statistical significances (P<0.05) . However, the MSTS 93 score for limb function and survival states remained unchanged significantly with time of the follow-up (P>0.05) . During the follow-up, 5 patients had pul- monary metastasis, 3 of them died of multiple metastasis and 2 survived with tumor, accounting for 35.71%, whereas the remaining 9 patients survived without tumor, accounting for 64.29%. [Conclusion] This individualized 3D printed prosthetic reconstruction is a sound choice for massive bone defect secondary to en bloc resection of primary malignant bone tumor on the shaft in the extremities.