Paediatric Orthopaedic Department, University Children's Hospital UKBB, 4056, Basel, Switzerland; Bone and Soft Tissue Tumor Center KWUB, University Hospital of Basel, 4054, Basel, Switzerland.
Paediatric Orthopaedic Department, University Children's Hospital UKBB, 4056, Basel, Switzerland; University of Basel, 4056, Basel, Switzerland.
Surg Oncol. 2022 Jun;42:101733. doi: 10.1016/j.suronc.2022.101733. Epub 2022 Mar 31.
Customized accurate tumor resection and individualized reconstruction is a challenging in treatment of malignant bone tumor. Three-dimensional (3D)-printing technique is now widely used in the resection and following reconstruction of malignant bone tumor, which included but not limited to tumor model, osteotomy guide and customized implant.
We retrospectively reviewed 17 patients, who underwent limb salvage surgery by using 3D-printed guide at a single center between August 2014 and October 2019. The median duration of follow-up was 26.5 months. Osteosarcoma (41.2%) were the predominant diagnoses. The functional outcomes were assessed by Musculoskeletal Tumor Society (MSTS) functional score. We also analyzed survival status, intraoperative data (blood loss, operation time and resection length), reconstruction method, margin outcomes and complications.
We totally performed 93 guided osteotomies on affected bone and allograft bone in 17 patients. Reconstruction in 12 cases was performed with biological technique: allograft combined with autograft was used in 7 cases. 11 of 12 (91.7%) cases showed a good bone healing in both allograft and autograft. 1 of 12 (8.3%) cases had allograft necrosis. Additional intra-operative extracorporeal radiation was performed in 3 pelvic cases for reconstruction. 63 of 64 (98%) osteotomies achieved wide resection and negative margin. All the cases had successful limb salvage result without amputation. At the latest follow up, the mean MSTS Score was 24 (range: 13-30), 12 patients alive with no evidence of disease, 1 patient alive with disease, 5 patients had died of disease and 5 years overall survival is 73.3%. The most common complications are wound healing disorder in 4 cases (23.5%) and infection in 3 cases (17.6%).
The 3D-printed resection guide was easy to use and showed promise in the field of orthopedic oncology. It can not only used in primary malignant bone tumor personalized resection but also in shaping structural bone allograft in biological reconstruction, which can achieve a safety surgical margin and individualized resection at the same time.
在恶性骨肿瘤的治疗中，精确的肿瘤切除和个体化重建是一个挑战。三维（3D）打印技术现在广泛应用于恶性骨肿瘤的切除和后续重建，包括但不限于肿瘤模型、截骨导板和定制植入物。
我们回顾性分析了 2014 年 8 月至 2019 年 10 月在单一中心接受 3D 打印导板辅助保肢手术的 17 例患者。中位随访时间为 26.5 个月。骨肉瘤（41.2%）是主要诊断。采用肌肉骨骼肿瘤学会（MSTS）功能评分评估功能结果。我们还分析了生存状况、术中数据（出血量、手术时间和切除长度）、重建方法、切缘结果和并发症。
我们共对 17 例患者的受影响骨和同种异体骨进行了 93 次引导性截骨。12 例患者采用生物技术进行重建：7 例采用同种异体骨联合自体骨。12 例（91.7%）患者的同种异体骨和自体骨均愈合良好。1 例（8.3%）患者出现同种异体骨坏死。3 例骨盆重建患者术中行额外的体外放射治疗。64 例中的 63 例（98%）获得广泛切除和阴性切缘。所有患者均成功保肢，无截肢。末次随访时，平均 MSTS 评分为 24 分（范围：13-30 分），12 例患者无病存活，1 例患者有病存活，5 例患者因病死亡，5 年总生存率为 73.3%。最常见的并发症是 4 例（23.5%）切口愈合不良和 3 例（17.6%）感染。
3D 打印截骨导板在骨肿瘤领域具有良好的应用前景，不仅可用于原发性恶性骨肿瘤的个体化切除，还可用于结构性骨同种异体骨的生物重建，在获得安全切缘的同时实现个体化切除。
