LARS韧带联合3D打印假体在肿瘤切除桡侧半腕关节重建术中的应用研究

Application of LARS ligament combined with three-dimensional printed prosthesis in reconstruction of radial hemicarpal joint after tumor resection

目的 探讨桡骨远端肿瘤切除术后联合应用LARS韧带和3D打印假体进行桡侧半腕关节重建的疗效。方法 回顾分析2017年9月—2021年3月12例桡骨远端肿瘤切除后联合应用LARS韧带和3D打印假体行桡侧半腕关节重建患者的临床资料。男7例,女5例;年龄19~63岁,平均41.8岁。左侧8例,右侧4例。骨巨细胞瘤10例,骨肉瘤2例。病程1~20个月,平均8.1个月。记录患者截骨长度、手术时间及术中出血量;手术前后采用Mayo腕关节功能评分和美国肌肉骨骼肿瘤学会(MSTS)评分评价腕关节功能;以与健侧上肢握力的百分比表示患肢握力,并测量腕关节活动度(range of motion,ROM),包括背伸、屈曲、桡偏、尺偏;影像学随访观察腕关节骨-假体界面上的骨长入及骨整合情况;记录腕关节并发症发生情况。结果 12例患者均顺利完成手术,截骨长度5.0~10.5 cm,平均6.8 cm;手术时间180~250 min,平均213.8 min;术中出血量30~150 mL,平均61.7 mL。患者均获随访,随访时间11~52个月,平均30.8个月。影像学随访示所有患者均可观察到骨-假体界面上的骨长入及骨整合现象,并逐渐实现生物固定。随访期间腕关节稳定性、运动功能及活动范围良好,无关节炎、半脱位、假体松动、感染等并发症,未发生肿瘤复发、转移等。末次随访时Mayo评分和MSTS评分分别为(82.1±5.4)、(27.5±1.5)分,较术前(48.8±13.5)、(16.4±1.4)分均显著改善(t=-10.761,P<0.001;t=-26.600,P<0.001)。患侧握力达健侧握力的59%~88%,平均70.5%。腕关节ROM分别为:背伸55°~80°,平均65.42°;屈曲35°~60°,平均44.58°;桡偏10°~25°,平均17.92°;尺偏10°~25°,平均18.33°。结论 联合应用LARS韧带和3D打印假体是桡骨远端肿瘤切除术后重建骨骼及关节缺损的一种有效方式,可以改善腕关节功能,减少并发症发生,并提高腕关节稳定性。

Objective To investigate the effectiveness of LARS ligament and three-dimensional(3D) printed prosthesis on the combined reconstruction of radial hemicarpal joint after distal radius tumor resection.Methods The clinical data of 12 patients with combined reconstruction of radial hemicarpal joint with LARS ligament and 3D printed prosthesis after distal radius tumor resection between September 2017 and March 2021 were retrospectively analyzed.There were 7 males and 5 females with an average age of 41.8 years(range,19-63 years).There were 8 cases on the left side and 4 cases on the right side,and 10 cases of giant cell tumor of bone and 2 cases of osteosarcoma.The disease duration ranged from 1 to 20 months,with an average of 8.1 months.The osteotomy length,operation time,and intraoperative blood loss were recorded,and the wrist function was evaluated by Mayo wrist score and Musculoskeletal Tumor Society(MSTS) score before and after operation.The grip strength of the affected limb was expressed by the percentage of grip strength of the healthy upper limb,and the range of motion(ROM) of the wrist joint was measured,including extension,flexion,radial deviation,and ulnar deviation;the bone ingrowth and osseointegration at the bone-prosthesis interface of the wrist joint were observed by radiographic follow-up;the possible wrist complications were recorded.Results All 12 patients successfully completed the operation.The osteotomy length was 5.0-10.5 cm(mean,6.8 cm),and the operation time was 180-250 minutes(mean,213.8 minutes).The intraoperative blood loss was 30-150 mL(mean,61.7 mL).All patients were followed up 11-52 months(mean,30.8 months).Radiographic follow-up showed that bone ingrowth and osseointegration at the bone-prosthesis interface were observed in all patients,and biological fixation was gradually achieved.During the follow-up,the stability,motor function,and ROM of the wrist joint were good.There was no complication such as arthritis,subluxation,prosthesis loosening,and infection,and no tumor recurrence and metastasis.At last follow-up,the Mayo score was 82.1±5.4,and MSTS score was 27.5±1.5,which were significantly improved when compared with those before operation(48.8±13.5,16.4±1.4;t=-10.761,P<0.001;t=-26.600,P<0.001).The grip strength of the affected side was 59%-88% of that of the healthy side,with an average of 70.5%.The ROM of wrist joint were 55°-80°(mean,65.42°) in extension,35°-60°(mean,44.58°) in flexion,10°-25°(mean,17.92°) in radial deviation,10°-25°(mean,18.33°) in ulnar deviation.Conclusion The combined application of LARS ligament and 3D printed prosthesis is an effective way to reconstruct bone and joint defects after distal radius tumor resection.It can improve the function of wrist joint,reduce the incidence of complications,and improve the stability of wrist joint.