Zhao Dingyun, Tang Fan, Min Li, Lu Minxun, Wang Jie, Zhang Yuqi, Zhao Kun, Zhou Yong, Luo Yi, Tu Chongqi
Department of Orthopeadics, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China.
Department of Orthopeadics, Tianjin Fifth Central Hospital, Tianjin 300450, People's Republic of China.
Cancer Manag Res. 2020 Apr 8;12:2503-2512. doi: 10.2147/CMAR.S245949. eCollection 2020.
This study aimed to evaluate the early stability, limb function, and mechanical complications of 3D-printed porous prosthetic reconstruction for "ultra-critical sized bone defects" following intercalary tibial tumor resections.
This study defined an "ultra-critical sized bone defect" in the tibia when the length of segmental defect in the tibia was >15.0 cm or >60% of the full tibia and the length of the residual fragment in proximal or distal tibia was between 0.5 cm and 4.0 cm. Thus, five patients with "ultra-critical sized bone defects" following an intercalary tibial malignant tumor resection treated with 3D-printed porous prosthesis between June 2014 and June 2018 were retrospectively reviewed. Patient information, implants design and fabrication, surgical procedures, and early clinical outcome data were collected and evaluated.
Among the five patients, three were male and two were female, with an average age of 30.2 years. Pathological diagnoses were two osteosarcomas, one Ewing sarcoma, one pseudo-myogenic hemangioendothelioma, and one undifferentiated pleomorphic sarcoma . The average length of the bone defects following tumor resection was 22.8cm, and the average length of ultra-short residual bone was 2.65cm (range=0.6cm-3.8cm). The mean follow-up time was 27.6 months (range=14.0-62.0 months). Early biological fixation was achieved in all five patients. The average time of clinical osseointegration at the bone-porous interface was 3.2 months. All patients were reported to be pain free and have no limitations in their walking distance. No prosthetic mechanical complications were observed.
Reconstruction of the "ultra-critical sized bone defect" after an intercalary tibial tumor resection using 3D-printed porous prosthesis achieved satisfactory overall early biological fixation and limb function. Excellent primary stability and the following rigid biological fixation were key factors for success. The outcomes of this study were supposed to support further clinical application and evaluation of 3D-printed porous prosthetic reconstruction for "ultra-critical sized bone defects" in the tibia.
本研究旨在评估3D打印多孔假体重建在胫骨节段性肿瘤切除术后治疗“超临界尺寸骨缺损”的早期稳定性、肢体功能及机械并发症。
本研究将胫骨节段性缺损长度>15.0 cm或超过胫骨全长的60%，且胫骨近端或远端残余骨块长度在0.5 cm至4.0 cm之间定义为胫骨“超临界尺寸骨缺损”。因此，对2014年6月至2018年6月间接受3D打印多孔假体重建治疗的5例胫骨节段性恶性肿瘤切除术后出现“超临界尺寸骨缺损”的患者进行回顾性分析。收集并评估患者信息、植入物设计与制造、手术过程及早期临床结果数据。
5例患者中，男性3例，女性2例，平均年龄30.2岁。病理诊断为2例骨肉瘤、1例尤因肉瘤、1例假肌源性血管内皮瘤和1例未分化多形性肉瘤。肿瘤切除术后骨缺损平均长度为22.8cm，超短残余骨平均长度为2.65cm（范围=0.6cm - 3.8cm）。平均随访时间为27.6个月（范围=14.0 - 62.0个月）。所有5例患者均实现早期生物学固定。骨 - 多孔界面临床骨整合平均时间为3.2个月。所有患者均报告无疼痛，行走距离无受限。未观察到假体机械并发症。
使用3D打印多孔假体重建胫骨节段性肿瘤切除术后的“超临界尺寸骨缺损”，早期生物学固定和肢体功能总体效果满意。优异的初始稳定性及随后的牢固生物学固定是成功的关键因素。本研究结果应支持3D打印多孔假体重建胫骨“超临界尺寸骨缺损”的进一步临床应用及评估。
