3D打印组配式骨盆假体重建骨盆肿瘤切除后骨缺损

Reconstruction with 3D-printed modular pelvic endoprostheses after pelvic tumor resection

目的 探讨骨盆肿瘤切除后理想的骨盆环及髋关节功能重建方法,验证3D打印技术用于骨盆重建的可行性.方法 2013年9月至2015年12月,共有35例患者接受骨盆肿瘤切除、3D打印组配式骨盆假体重建手术.根据En-neking骨盆外科分区方法确定切除及重建部位：Ⅰ区3例、Ⅱ＋Ⅲ区12例、Ⅰ＋Ⅱ区5例、Ⅰ＋Ⅱ＋Ⅲ区2例、Ⅰ＋Ⅱ＋Ⅳ区10例、Ⅰ＋Ⅱ＋Ⅲ＋Ⅳ区3例.重建方法：3例应用3D打印髂骨假体,12例使用3D打印标准半骨盆假体,20例使用3D打印钉-棒半骨盆假体.结果 35例患者均为整块切除.肿瘤切除边界达到广泛切除15例,边缘切除14例,囊内切除6例,肿瘤切除边界满意率为82.9％（29/35）.术后均获得随访,随访时间6～30个月,平均20.5个月.无瘤生存25例,带瘤生存5例,余5例因肿瘤转移而死亡.采用MSTS-93量表进行功能评价,30例存活患者末次随访时功能评分为9～26分,平均19.1分.3例应用髂骨假体重建者功能评分为20～25分,平均22.7分;12例应用标准半骨盆假体重建者为15～26分,平均19.8分;15例应用钉-棒半骨盆假体重建者为9～25分,平均17.7分.术后并发症包括7例切口延迟愈合及2例髋关节脱位,无一例发生深部感染.结论 应用3D打印技术制造骨盆假体有利于假体与截骨面的精确匹配及骨长入.短期随访结果证实应用3D打印组配式骨盆假体重建骨盆肿瘤切除后骨缺损的安全性高,不增加额外并发症,并可获得良好的功能状态.

Objective To investigate the ideal reconstruction methods after pelvic tumor resection and to assess the feasibility of three-dimensional （3D） printing technology for pelvic reconstruction,we performed a retrospective study of patients with pelvic tumors who received tumor resection and reconstruction using 3D-printed pelvic endoprostheses.Methods Thirty-five patients received tumor resection and functional reconstruction with 3D-printed pelvic endoprostheses in our center from Sep.2013 to Dec.2015.According to Enneking＆#39; s classification,there were 3 cases of Type Ⅰ,12 cases of Type Ⅱ＋Ⅲ,5 cases of Type Ⅰ＋Ⅱ,2 case of Type Ⅰ＋Ⅱ＋Ⅲ,10 cases of type Ⅰ＋Ⅱ＋Ⅳ and 3 cases of type Ⅰ＋Ⅱ＋Ⅲ＋Ⅳ resection.Methods of reconstruction included 3 patients with 3D-printed iliac endoprosthesis,12 patients with 3D-printed standard hemipelvic endoprosthesis and 20 patients with 3D-printed screw-rod connected hemipelvic endoprosthesis.Results All 35 patients underwent en bloc resection.Margins were wide in 15 cases,marginal in 14 cases and intralesional in 6 cases.After a mean followed-up of 20.5 months （6 to 30）,25 patients survived without evidence of disease,5 patients were alive with diseases and 5 patients died of distant metastasis.Complications included 7 cases of delayed wound healing,2 cases of hip dislocation and no cases of deep infection.The average MSTS 93 score was 19.1 （9-26） for all of the 30 alive patients,22.7 （20 to 25） for 3 patients with iliac endoprosthesis reconstruction,19.8 （15 to 26） for 12 patients with standard hemipelvic endoprosthesis reconstruction,and 17.7 （9 to 25） for 15 patients with screw-rod connected hemipelvic endoprosthesis at the last follow up.Conclusion The application of 3D-printing technology could facilitate precise matching and osseointegration between the implants and host bone.Our clinical results proved that application of 3D-printed pelvic endoprostheses for reconstruction of bony defect was safe without additional complications,and that good functional results could be expected during short-term follow-up.