APC重建技术联合3D打印个性化非限制性全膝置换在胫骨上段恶性肿瘤中的应用

Application of APC reconstruction technique combined with 3D printing personalized non-restrictive total knee replacement in the treatment of upper tibial malignant tumor

目的探究同种异体骨-假体复合物(APC)重建技术联合3D打印个性化非限制性全膝置换(TKR)治疗胫骨上段恶性肿瘤的临床疗效。方法回顾性分析南部战区总医院2005年1月至2015年1月收治的25例胫骨上段恶性肿瘤患者的临床资料。根据术式不同分为个性化手术组和常规手术组,个性化手术组12例,采用APC重建技术联合3D打印个性化非限制性TKR治疗;常规手术组13例,采用常规手术+铰链式假体治疗。比较两组患者瘤段切除长度、术中出血量、手术时间以及术后双下肢长度差、力线偏移和并发症发生情况,记录两组随访期间肿瘤复发率、膝关节活动度以及骨与软组织肿瘤学会(MSTS)膝关节功能评分。结果两组患者瘤段切除长度、术中出血量、并发症发生率及肿瘤复发率比较,差异无统计学意义(P>0.05)。个性化手术组手术时间、术后肢体长度差和力线偏移度明显少于常规手术组,术后1、3年膝关节主动屈曲度及MSTS膝关节功能评分明显高于常规手术组(P <0.05)。结论与常规手术联合铰链式假体相比,APC重建技术联合个性化非限制性TKR治疗胫骨上段恶性肿瘤解剖匹配精度高,节省手术时间,能提供良好的术后功能,临床效果满意。

Objective To explore the clinical efficacy of allograft-prosthetic composite (APC) reconstruction technique combined with 3D printing personalized non-restrictive total knee replacement (TKR) for upper tibial malignant tumors. Methods Clinical data of 25 patients with upper tibial malignant tumor treated in General Hospital of Southern Theater Command from January 2005 to January 2015 were analyzed retrospectively. According to different surgical approaches, the patients were divided into personalized surgery (n = 12) and routine surgery groups (n = 13). Patients in personalized surgery group were performed APC reconstruction technique combined with 3D printing personalized non-restrictive TKR, while patients in routine surgery group were treated with conventional procedure with hinged prosthesis. Tumor resection length, estimate intraoperative bleeding volume, operation time, postoperative length difference between lower limbs and limb alignment deviation, postoperative complications were compared between two groups, tumor recurrence, range of motion (ROM) of knee joint and Musculoskeletal Tumor Society (MSTS) knee joint function scores during the follow-up in two groups were also recorded. Results There were no significant differences in tumor resection length, estimate intraoperative bleeding volume, incidence of complications and tumor recurrence incidence (P >0.05). Operation time, postoperative limb length difference and alignment deviation in personalized surgery group were lower than those in routine surgery group, knee joint active ROM and MSTS function scores at 1, 3 years postoperatively were higher than those in routine surgery group (P <0.05). Conclusions For patients with upper tibial malignant tumor, APC reconstruction method combined with personalized non-restrictive TKR could obtain satisfactory clinical efficacy with the advantages of high anatomical matching accuracy, less operation time, good postoperative function recovery when compared with conventional procedure + hinged prosthesis.