3D打印辅助术前设计在髋臼周围软骨肉瘤切除与半骨盆假体置换术中的应用

Application of 3D printing technology aided preoperative design in periacetabular chondrosarcoma resection and semi pelvic prosthesis replacement

目的探讨3D打印技术辅助术前手术方案设计在髋臼周围软骨肉瘤切除与半骨盆假体置换术中的临床应用效果。方法纳入自2005-06—2015-02行肿瘤切除、半骨盆假体置换术治疗的38例髋臼周围软骨肉瘤,18例采用3D打印技术辅助术前手术方案设计(3D打印组),20例采用传统方案定制假体(传统组)。比较2组手术时间、术中出血量、术后双下肢不等长距离、髋臼倾斜角度在安全范围的例数,以及末次随访时的关节功能。结果 38例均获得随访,随访时间平均27.3(10~61)个月。与传统组比较,3D打印组手术时间更短,术中出血量更少,术后双下肢不等长距离更短,差异有统计学意义(P<0.05)。2组髋臼倾斜角度在安全范围的例数、切口并发症例数、末次随访时MSTS 93评分比较差异无统计学意义(P>0.05)。结论髋臼周围软骨肉瘤切除与半骨盆假体置换术前3D打印技术辅助手术方案设计具有可行性,有利于术中肿瘤快速切除及假体准确安装,可减少手术时间及术中出血量,也在一定程度上简化了手术操作。

Objective To investigate the application of 3D printing technology aided preoperative design in periacetabular chondrosarcoma resection and semi pelvic prosthesis replacement. Methods From June 2005 to February 2015, tumor resections and hemi pelvic prosthesis replacement treatments were performed in 38 cases of acetabular chondrosarcoma. All patients were divided into two groups. The preoperative design of 3D printing was used in 18 cases （the 3D printing group） while the traditional scheme with custom prosthesis was used in 20 cases （the traditional group）. The operation time, the bleeding volume, the postoperative unequal length of lower extremities, the number of cases of which the acetabular inclination angle was in safe place and function at the last follow-up were compared between the two groups. Results All 38 cases were followed up, and the average follow-up time was 27.3 （10-61） months. In the 3D printing group, the operation time was shorter, the bleeding volume was less and the postoperative unequal length of lower extremities was shorter than that in the traditional group, the difference was statistically significant （P 〈0.05）. There was no significant difference in the number of cases whose acetabular inclination angle was in safe place, the number of cases with complications and the MSTS 93 score at the last follow-up between the 2 groups （P 〉0.05）. Conclusion It is feasible to apply 3D printing technology to aid preoperative design in periacetabular chondrosarcoma resection and semi pelvic prosthesis replacement, which not only can significantly reduce the volume of bleeding and operation time, but also can simplify the operation.