3D打印髌骨假体治疗髌骨骨巨细胞瘤的早期疗效评估

Early efficacy of 3D-printed patella prosthesis for giant cell tumor of patella

目的探讨3D打印髌骨假体的手术技巧及假体治疗髌骨骨巨细胞瘤的早期疗效。方法四川大学华西医院2016年1月至2021年8月髌骨骨巨细胞瘤患者4例行髌骨肿瘤En-bloc切除+3D打印髌骨假体重建术。对于髌韧带不能保留者,加行自体肌腱移植术。结果本组随访时间为(36.25±5.5)个月,与术前数据对比,末次随访时,患侧膝关节主动屈曲角度由(22.50±6.45)°~(76.25±4.79)°提升至0~(112.50±9.57)°;肌力强度由(2.75±0.50)级提升至(5.00±0.00)级;骨与软组织肿瘤协会(MSTS)评分由(12.25±1.71)分提升至(27.25±1.71)分;视觉模拟评分(VAS)由(6.00±0.82)分提升至(0.25±0.50)分;insall-salvati比值(ISR)由1.36±0.10提升至0.96±0.05。差异均有统计学意义(P<0.05)。术中1例髌韧带全部切除,使用自体肌腱移植,术后患者功能稍差,余3例股四头肌肌腱及髌韧带未受肿瘤侵犯,术中直接重建。将3例直接重建膝关节周围韧带的患者术后末次随访情况进行对比,膝关节主动屈曲、伸直角度、肌力强度、MSTS评分、VAS评分及ISR比值均差异无统计学意义(P>0.05)。本组病例未见肌腱断裂、假体脱位、假体松动、假体周围感染及肿瘤转移、复发等相关并发症。结论3D打印定制髌骨假体凭借其个性化的精准设计、生物型固定方式在治疗CampanacciⅢ级、复发性髌骨骨巨细胞瘤方面短期疗效显著。临床应用中应注重术前髌韧带及股四头肌肌腱受累情况的评估和软组织重建技术。

Objective To explore the effect of 3D-printed patellar endoprosthesis on the treatment for giant cell tumor of patella in early stage.Methods From January 2016 to August 2021,4 patients diagnosed as giant cell tumor of patella were treated with En-bloc resection combined with 3D-print patellar endoprosthesis.Autografting of tendons was used for the patients whose patellar tendon could not be preserved completely.Results The follow-up time was(36.25±5.5)months.No local recurrence and metastasis was found in this group of patients.At the end of the follow-up,the affected knee flexion arc was significantly improved from(22.50±6.45)°~(76.25±4.79)°to 0~(112.50±9.57)°.The strength of active knee extension was significantly improved from(2.75±0.50)grade to(5.00±0.00)grade.The Musculoskeletal Tumor Society(MSTS)scale was significantly improved from(12.25±1.71)points to(27.25±1.71)points.The score of Visual Analog Scale(VAS)was significantly improved from(6.00±0.82)points to(0.25±0.50)points.The Insall-Salvati ratio(ISR)was significantly improved from 1.36±0.10 to 0.96±0.05.The MSTS score was significantly increased from(12.25±1.71)points to(27.25±1.71)points postoperatively.One patient received autografting of tendons who got a relatively poor postoperative function.There was no statistical difference in the extensor mechanism in the rest of patients with directly repair on consequent defect.No soft tissue failures,aseptic prosthesis loosening,structural failures,infection,tumor progression and other prosthesis related complications occurred.Conclusions 3D-printing custom-made patellar endoprosthesis is a good choice for the Campanacci gradeⅢor recurrent giant cell tumor in patella for personalized design and fixation.In clinical application,the evaluation of preoperative the quadriceps tendon,patellar tendon and the intraoperative soft tissue repair techniques should be paid attention to.