3D打印半骨盆假体置换治疗EnnekingⅡ+Ⅲ区骨盆恶性肿瘤的疗效评估

Evaluation of the Efficacy of 3D-Printed Hemipelvic Prosthesis Replacement Surgery in the Treatment of Enneking StageⅡ+ⅢMalignant Pelvic Tumors

目的探讨3D打印半骨盆假体置换治疗EnnekingⅡ+Ⅲ区骨盆恶性肿瘤的疗效及保留髂前下棘的安全性及有效性。方法收集2018年1月至2020年1月进行3D打印半骨盆假体置换的25例骨盆Ⅱ+Ⅲ区恶性肿瘤患者资料。男11例,女14例;年龄17~77岁,平均(49.96±9.73)岁。其中普通型骨肉瘤11例,软骨肉瘤6例,毛细血管扩张型骨肉瘤3例,尤文氏肉瘤3例,转移性副神经节瘤(原发部位为腰椎)1例,转移性肾透明细胞癌1例。其中根据手术方式不同分为研究组(保留髂前下棘,10例)和对照组(未保留髂前下棘,15例)。记录两组患者手术时间及术中出血量。通过影像学评估假体的髋臼旋转中心偏移情况。以肌肉骨骼肿瘤协会评分(musculoskeletal tumor society,MSTS)、Harris髋关节功能评分及美国特种外科医院(hospital for special surgery,HSS)膝关节功能评分进行评估,并记录肿瘤学预后及并发症。结果随访时间16~27个月,平均为(21.92±3.40)个月。研究组与对照组手术时间及术中出血量对比差异均无统计学意义(P>0.05)。术后及末次随访时,研究组MSTS功能评分、Harris髋关节功能评分、HSS膝关节功能评分均高于对照组,差异均有统计学意义(P<0.05)。末次随访时,研究组与对照组的假体髋臼旋转中心偏移对比差异无统计学意义(P>0.05)。术后3例患者出现术区感染,2例出现切口周围脂肪液化坏死,经治疗后痊愈。末次随访时1例骨盆转移瘤患者在术后1年发现肝转移,靶向药物控制,带瘤存活;其余患者均未发现肿瘤复发及转移。结论3D打印半骨盆假体置换治疗骨盆EnnekingⅡ+Ⅲ区恶性肿瘤是一种安全、有效的手术方法。此外,保留髂前下棘及肌肉附着点对髋关节及膝关节功能恢复具有重要的意义。

Objective To assess the therapeutic efficacy of 3D-printed hemipelvic endoprosthesis replacement in managing Enneking stageⅡ+Ⅲpelvic malignant tumors and evaluate the safety and functional outcomes associated with preserving the anterior inferior iliac spine during the surgical procedure.Methods This retrospective study encompassed a cohort of 25 patients diagnosed with Enneking stageⅡ+Ⅲpelvic malignant tumors who underwent 3D-printed hemipelvic endoprosthetic replacement surgery at our institution from January 2018 to January 2020.The patient demographics included 11 males and 14 females,with ages ranging from 17 to 77 years,yielding a mean age of(49.96±9.73)years.The tumor histologies comprised 11 cases of conventional osteosarcoma,6 of chondrosarcoma,3 of telangiectatic osteosarcoma,3 of Ewing’s sarcoma,1 case of metastatic paraganglioma originating from the lumbar spine,and 1 case of metastatic renal clear cell carcinoma.Based on the surgical approach adopted,patients were categorized into two groups:a study group(10 patients)where the anterior inferior iliac spine was preserved during surgery,and a control group(15 patients)where it was not retained.Intraoperative metrics,such as surgical duration and blood loss,were recorded for both groups.Prosthetic acetabular rotation center displacement was evaluated using imaging techniques.Postoperative assessments were performed utilizing the musculoskeletal tumor society(MSTS)score,Harris hip function score,and hospital for special surgery(HSS)knee function score.Furthermore,oncological outcomes,including recurrence rates and survival data,were analyzed.Complications encountered during and after surgery were also documented and analyzed.Results The follow-up period for all patients ranged from 16 to 27 months,averaging at(21.92±3.40)months.Analysis revealed no statistically significant differences in surgical duration or intraoperative blood loss between the study group(with preserved anterior inferior iliac spine)and the control group(without preservation)(P>0.05).However,at both postoperative and final follow-up assessments,the study group demonstrated significantly higher MSTS functional scores,Harris hip scores,and HSS knee scores compared to the control group,with statistically significant differences observed(P<0.05).Notably,the comparison of acetabular prosthetic rotation center offset between the two groups at the last follow-up did not yield statistically significant differences(P>0.05).Postoperative complications included 3 cases of surgical site infections and 2 instances of fat liquefaction necrosis around the incision site,all of which resolved with appropriate treatment.During the last follow-up,one patient with pelvic metastatic tumor was diagnosed with liver metastasis one year after surgery.This patient was managed with targeted therapy and remained alive with the tumor under control.No instances of tumor recurrence or metastasis were observed in the remaining patients.Conclusion Our study concludes that 3D-printed hemipelvic prosthesis surgery represents a safe and effective therapeutic approach for managing Enneking stageⅡ+Ⅲpelvic malignant tumors.Furthermore,the preservation of the anterior inferior iliac spine and associated muscle attachment points during surgery is pivotal in facilitating optimal functional recovery of the hip and knee joints,as evidenced by the superior functional outcomes observed in the study group.This surgical technique offers a promising option for improving both oncological outcomes and quality of life for patients with complex pelvic malignancies.