3D打印截骨导板在股骨远端骨肉瘤肿瘤切除、假体重建术中的应用

Clinical application of 3D printing guild plate in tumor resection and reconstruction with prosthesis in patients with distal femoral osteosarcoma

目的探讨3D打印截骨导板在股骨远端骨肉瘤肿瘤切除、假体重建术中的临床应用效果。方法回顾分析2012年1月至2016年2月于我科行股骨远端骨肉瘤肿瘤切除、假体重建手术的患者63例,男28例,女35例;年龄6~33岁,平均10.7岁。所有患者都是未经治疗的ⅡB期原发骨肉瘤。所有患者都经过标准术前化疗、行肿瘤型人工膝关节置换手术,按是否采用3D打印截骨导板分为3D打印导板组30例及常规组33例,比较两组手术时间、出血量、术后肢体与健侧长度差、下肢力线角度、关节活动度、MSTS功能评分情况。结果所有患者手术顺利,手术中病变彻底切除,3D打印导板组手术时间(1.6±0.3)h,与常规组(2.2±0.5)h比较差异有统计学意义(P=0.000);3D打印导板组术中出血量(156.4±12.3)ml,与常规组(176.8±21.6)ml比较差异有统计学意义(P=0.000);3D打印导板组术后肢体长度与健侧差异平均(0.3±0.1)cm,与常规组(0.5±0.1)cm比较差异有统计学意义(P=0.000);3D打印导板组术后股骨与胫骨机械轴夹角为(2.8±0.6)°,与常规组(3.0±0.4)°比较差异无统计学意义(P=0.309);3D打印导板组术后2周膝关节活动范围为(101.7±9.1)°,常规组(101.4±7.3)°,两组差异无统计学意义(P=0.897);3D打印导板组术后MSTS功能评分(21.9±3.3)分,与常规组(22.2±2.4)分比较差异无统计学意义(P=0.762)。结论 3D打印截骨导板在股骨远端骨肉瘤肿瘤切除、假体重建术的治疗中,下肢力线、关节活动度、功能评分与常规手术无异,但术后肢体与健侧差异更小,手术时间、出血量更少。

Objective To evaluate the clinical application of 3D printing guild plate in tumor resection and reconstruction with prosthesis in patients with distal femoral osteosarcoma. Methods From January 2012 to February 2016, tumor resection and reconstruction with prosthesis were performed in 63 patients（ 28 males, 35 females） with distal femoral osteosarcoma. The average age was 10.7 years（ range： 6-33 years）. All the patients sustained primary osteosarcoma in stage ⅡB without treatment in other hospitals, who underwent standard preoperative chemotherapy, reconstruction with prosthesis. According to the application of 3D printing guild plate or not, 63 patients were divided into 2 group： the 3D printing group（ 30 cases） and the traditional group（ 33 cases）. Operation time, bleeding volume, postoperative limb length, lower limb mechanical alignment, range of motion（ ROM） and post-operative Musculoskeletal Tumor Society score（ MSTS） were compared between the 2 groups. Results All patients were operated successfully, and the lesions were completely removed during the operations. The operation time was（ 1.6 ± 0.3） h in the 3D printing group and（ 2.2 ± 0.5） h in the traditional group, with statistically significant differences（ P = 0.000）. The amount of bleeding was（ 156.4 ± 12.3） ml in the 3D printing group and（ 176.8 ± 21.6） ml in the traditional group, with statistically significant differences（ P = 0.000）. The postoperative limb length compared with the ipsilateral extremity was（ 0.3 ± 0.1） cm in the 3D printing group and（ 0.5 ± 0.1） cm in the traditional group,with statistically significant differences（ P = 0.000）. The lower limb mechanical alignment was（ 2.8 ± 0.6） ° in the 3D printing group and（ 3.0 ± 0.4） ° in the traditional group, with no statistically significant differences（ P = 0.309）. The range of motion（ ROM） was（ 101.7 ± 9.1） ° in the 3D printing group and（ 101.4 ± 7.3） ° in the traditional group, with no statistically significant differences（ P = 0.897）. The post-operative Musculoskeletal Tumor Society score（ MSTS） was（ 21.9 ± 3.3） in the 3D printing group and（ 22.2 ± 2.4） in the traditional group, with no statistically significant differences（ P = 0.762）. Conclusions The tumor resection and reconstruction with prosthesis with 3D printing guild plate in patients with distal femoral osteosarcoma has similar results to conventional treatment in mechanical alignment, ROM of the knee and MSTS score, but it shortens limb length difference, operation time and decreases the blood loss.