3D打印个性化填充假体治疗膝关节周围骨巨细胞瘤早期疗效

Treatment of giant cell tumor of bone around knee joint with three-dimensional printing personalized prosthesis

目的探讨3D打印个性化填充假体治疗膝关节周围骨巨细胞瘤的早期疗效。方法回顾分析2014年5月-2017年8月收治并符合选择标准的9例膝关节周围骨巨细胞瘤患者临床资料。男4例,女5例;年龄24~50岁,平均35.8岁。肿瘤部位:股骨远端4例,胫骨近端5例。病程5~25个月,平均12.9个月。根据Campanacci影像学分级系统分级:Ⅰ级2例,Ⅱ级7例。术前基于CT扫描及三维重建,设计并制作3D打印个性化填充假体。术中囊内扩大刮除、关节软骨下植骨后植入假体。术后影像学检查肿瘤有无复发,采用1993年美国骨肿瘤学会评分系统(MSTS93)评价关节功能。结果 9例手术均顺利完成。术后切口均Ⅰ期愈合,无早期并发症发生。患者均获随访,随访时间24~40个月,平均31.2个月。末次随访时,膝关节局部均无疼痛,无肿瘤复发、病理性骨折、假体松动等并发症发生。MSTS93评分为20~29分,平均24.7分;获优6例、良3例,优良率100%。结论膝关节周围骨巨细胞瘤囊内扩大刮除术后骨缺损采用3D打印个性化填充假体修复,具有能与宿主骨生物融合、力学稳定性更高、关节功能恢复良好的优点,可获得较好早期疗效,中远期疗效有待进一步随访。

Objective To investigate the short-term effectiveness of three-dimensional(3D)printing personalized prosthesis in the treatment of giant cell tumor of bone around knee joint.Methods A clinical data of 9 patients with giant cell tumor of bone around knee joints and met the inclusive criteria between May 2014 and August 2017 was retrospectively analysed.There were 4 males and 5 females,with an average age of 35.8 years(range,24-50 years).The lesion located at the distal femur in 4 cases and at the proximal tibia in 5 cases.The disease duration was 5-25 months(mean,12.9 months).According to Campanacci grading,there were 2 patients of gradeⅠand 7 of gradeⅡ.The 3D printing personalized prosthesis was designed based on the CT scanning and 3D reconstruction prepared before operation.All patients were treated with the tumor resection and 3D printing personalized prosthesis reconstruction.The radiological examination was taken to observe the tumor recurrence and the Musculoskeletal Tumor Society 1993(MSTS93)score was used to evaluate the knee function.Results All operations were successful and all incisions healed by first intention without early complications.All patients were followed up 24-40 months(mean,31.2 months).At last follow-up,no complication such as pain,pathological fracture,prosthesis loosening,or tumor recurrence occurred.The MSTS93 score was 20-29(mean,24.7).The knee function was rated as excellent in 6 cases and good in 3 cases,with the excellent and good rate of 100%.Conclusion For giant cell tumor of bone around knee joint,3D printing personalized prosthesis has the advantages of bio-fusion with host bone,mechanical stability,good joint function,and ideal short-term effectiveness.But the middle-and long-term effectiveness still need to be further observed.