3D打印多孔结构金属支撑假体治疗胫骨近端CampanacciⅠ、Ⅱ级骨巨细胞瘤的早期疗效评估

Short-term outcomes of three-dimensional printing metal support prosthesis with porous structure for Campanacci gradeⅠandⅡgiant cell tumor in proximal tibia

背景:胫骨近端骨巨细胞瘤多侵袭软骨下骨区域。目前瘤性骨缺损的重建方式主要为骨水泥填充联合自体骨植骨及接骨板螺钉内固定,该方案的局限性主要在于缺乏对软骨下骨区的保护和力学支持的不均衡。目的:介绍和评估3D打印多孔结构金属支撑假体的设计细节,以及首次运用于胫骨近端骨巨细胞瘤手术的要点和早期疗效。方法:2016年1月至2019年6月,5例CampanacciⅡ级,1例CampanacciⅠ级的胫骨近端骨巨细胞瘤患者接受3D打印多孔结构金属支撑假体重建。年龄26~48岁,平均(35.5±8.4)岁。术前影像学评估病变范围、受损软骨下骨的范围比例。术前、术后评价软骨下骨层厚度、膝关节疼痛、功能状况及活动度。术后评估宿主骨与自体植骨愈合情况、自体植骨及宿主骨在假体表面骨长入情况、肿瘤学预后及并发症。结果:患者随访12~42个月,平均(27.0±11.2)个月。术前胫骨平台软骨下骨受损范围比例平均61.0%±22.9%。末次随访时,软骨下骨层厚度较术前改善[(10.7±0.6)vs.(1.5±0.5)mm];膝关节VAS评分低于术前[0 vs.(5.7±1.2)分];膝关节屈曲范围较术前改善(121.7°±8.2°vs.105.8°±8.6°);1993年美国骨肿瘤协会(MSTS)下肢功能评分显著高于术前[(29.2±1.0)vs.(20.0±2.1)分]。所有患者软骨下植骨与宿主骨愈合,假体表面骨长入良好。所有患者均无局部复发或肺转移。结论:3D打印多孔结构金属支撑假体是胫骨近端瘤性骨缺损的精准重建方式,通过仔细的术前设计及术中操作,可达到良好生物整合下的生物力学支撑。

Background:Subchondral bone is commonly affected in cases of giant cell tumour of the proximal tibia.Currently,the main reconstruction methods of tumorous bone defects are bone cement filling combined with autogenous bone grafting and plate internal fixation.The limitations of this scheme are the lack of protection of subchondral bone and imbalance of mechanical support.Objective:To introduce and evaluate the design details of the 3D printing porous structure metal support prosthesis,as well as the surgical key points and early outcomes of its first application for tumorous bone defects from Campanacci gradeⅠorⅡgiant cell tumor in proximal tibia.Methods:From January 2016 to June 2019,5 patients with Campanacci gradeⅡand 1 patient with Campanacci gradeⅠgiant cell tumor in proximal tibia underwent 3D printing porous structure metal support prosthesis implantation with the mean age of(35.5±8.4)years(range:26-48).Preoperative images were used to evaluate the extent of lesion and the proportion of damaged subchondral bone.Subchondral bone thickness,knee pain,functional status and range of motion were comparatively evaluated preoperatively and postoperatively.Postoperative healing of host and autologous bone grafts,and bone ingrowth of prosthesis were assessed.Local recurrence,metastasis and complications were evaluated.Results:All patients were followed up for 12-42 months(mean,27.0±11.2 months).The preoperative average range of subchondral bone damage was 61.0%±22.9%.At the last postoperative follow-up,the subchondral bone layer thickness was improved([10.7±0.6]vs.[1.5±0.5]mm);VAS score of knee joint was lower(0 vs.5.7±1.2);the range of knee flexion was improved(121.7°±8.2°vs.105.8°±8.6°);Musculoskeletal Tumor Society score was significantly improved(29.2±1.0 vs.20.0±2.1)as compared with that before surgery.In all patients,the subchondral bone grafts were healed well with the host bone,and the bone ingrowth of the prosthesis was achieved.There was no local recurrence or pulmonary metastasis in all patients.Conclusions:3D printing porous structure metal support prosthesis is a precision reconstruction method for the tumorous bone defect in proximal tibia.Through careful preoperative design and intraoperative operation,it can achieve good biomechanical support under biological integration.