Min Li, Yao Kai, Lu Minxun, Zhou Yong, Wang Jie, Tang Fan, Zhang Wenli, Luo Yi, Duan Hong, Tu Chongqi
Department of Orthopedics, West China Hospital, Sichuan University, Guoxue Xiang #37, Chengdu, Sichuan, People's Republic of China.
Precis Clin Med. 2018 Sep;1(2):88-96. doi: 10.1093/pcmedi/pby008. Epub 2018 Aug 22.
3D design, which is widely used in orthopedics, can be applied for precise distal femoral megaprosthetic revision. This research aimed to present and evaluate the design, perioperative management, and mid-term clinical outcomes of a 3D design custom-made uncemented prosthetic stem.
Between January 2014 and January 2016, seven patients received 3D design custom-made uncemented prosthetic stem revision at our institution. Clinical records and radiographs were evaluated retrospectively.
There were no hardware-related complications during the follow-up (average 24.3 months; range 24-48 months). The average Musculoskeletal Tumor Society (MSTS) score at the last follow-up after revision (27.7 points, range 25-28 points) was significantly higher than that before (16.0 points, range 13-18 points). In addition, the range of motion (ROM) of the affected knee, and the scores of pain, function, emotional acceptance, support, walking and gait all improved significantly. The antecurvature radian of the revision stem averaged at 3.6°. Of the seven patients, three received femoral stem revision and four received revision of the femoral stem and the femoral component; three of them used longer prostheses than the others. There were no significant differences in function between these two groups at the last follow-up after revision.
The 3D design custom-made prosthesis is a typical precision medicine technology in oncologic orthopedics. Characterized by its individually and precisely designed uncemented stem, it offers an alternative option for distal femoral cemented prosthesis revision. Besides the 3D design itself, the perioperative management, especially the techniques for stem implantation, and long-term follow-up are also crucial.
3D设计在骨科领域应用广泛，可用于股骨远端大型假体的精准翻修。本研究旨在展示并评估一种3D设计定制的非骨水泥型假体柄的设计、围手术期管理及中期临床疗效。
2014年1月至2016年1月期间，7例患者在我院接受了3D设计定制的非骨水泥型假体柄翻修手术。对临床记录和X线片进行回顾性评估。
随访期间（平均24.3个月；范围24 - 48个月）未出现与硬件相关的并发症。翻修后末次随访时的平均肌肉骨骼肿瘤学会（MSTS）评分（27.7分，范围25 - 28分）显著高于术前（16.0分，范围13 - 18分）。此外，患膝的活动范围（ROM）以及疼痛、功能、情感接受度、支持度、行走和步态评分均有显著改善。翻修柄的前曲率弧度平均为3.6°。7例患者中，3例接受了股骨干翻修，4例接受了股骨干及股骨部件的翻修；其中3例使用的假体比其他患者的长。翻修后末次随访时，这两组在功能方面无显著差异。
3D设计定制假体是肿瘤骨科领域典型的精准医疗技术。其特点是个体化且精确设计的非骨水泥型柄，为股骨远端骨水泥型假体翻修提供了一种替代选择。除了3D设计本身，围手术期管理，尤其是柄植入技术以及长期随访也至关重要。
