3D打印假体治疗下肢长骨恶性骨肿瘤大段骨缺损的短期疗效

Application of 3D printing prosthesis in large segmental bone defect caused by malignant bone tumor of long bone of lower limb: a short-term clinical outcome

目的:探讨3D打印假体在下肢长骨恶性骨肿瘤大段骨缺损的早期应用效果。方法:分析2019年3月至2022年8月收治的11例下肢长骨恶性骨肿瘤切除患者利用3D打印假体重建患肢的临床效果。男6例,女5例;年龄8~63岁,平均(24.6±19.2)岁。肿瘤病理类型:普通型骨肉瘤8例,皮质旁骨肉瘤2例,恶性骨巨细胞瘤1例。所有患者均规范完成术前新辅助化疗后行手术治疗,术后定期临床随访及影像资料评估肿瘤复发、转移及假体并发症,采用国际肌肉骨骼肿瘤学会(MSTS)评分系统对肢体的功能状态进行评估。结果:11例患者术中截骨长度80~360 mm,平均(225.7±94.9)mm,骨缺损占比24.4%~88.9%。股骨侧肿瘤重建7例,胫骨侧肿瘤重建4例。术后随访3~34个月,平均(20.0±9.8)个月。肺转移、多发骨转移、接骨板断裂、假体周围骨折、假体松动各1例。末次随访MSTS评分为20~28分,平均(25.0±3.0)分;肢体短缩0~19 mm,中位数5 mm。讨论:3D打印假体兼备即刻稳定的金属重建技术和永久可靠的生物重建技术,可显著提升下肢长骨恶性骨肿瘤患者的生活质量。

Objective: To investigate early effect of 3D printing prosthesis in treatment of large segmental bone defect caused by malignant tumor of long bone of lower limb. Methods: The clinical outcomes of 3D printing prosthesis in 11 patients with bone malignant tumor of lower extremities treated from March 2019 to August 2022 were retrospectively analyzed. There were 6 males and 5 females with a mean age of(24.6±19.2) years(range, 8-63 years). There were 8 cases of common osteosarcoma, 2 cases of paracortical osteosarcoma and 1 case of malignant giant cell tumor of bone. All the patients received surgical treatment after neoadjuvant chemotherapy. Regular clinical follow-up and imaging data were used to evaluate tumor recurrence, metastasis and prosthetic complications. The Musculoskeletal Tumor Society(MSTS) score was used to evaluate the functional status of the limbs. Results: The mean lengh of bone defect was(225.7±94.9) mm(range, 80-360 mm) in the 11 patients, and the proportion of defect was 24.4%-88.9%. There were 7 cases of femoral tumor reconstruction and 4 cases of tibial tumor reconstruction. The patients were followed up for(20.0±9.8) months(range, 3-34 months). Lung metastasis occurred in 1 case, bone metastasis in 1 case, plate fracture in 1 case, periprosthetic fracture in 1 case and prosthesis loosening in 1 case. In the last follow-up, the mean MSTS score was 25.0±3.0(range, 20-28), and the median limb shortening was 5 mm(0-19 mm). Conclusions: The application of 3D printing prosthesis has both immediate stable metal reconstruction and permanent reliable biological reconstruction, which can significantly improve the quality of life of patients with bone malignant tumor of lower extremities.