Xu Shenglin, Guo Zehao, Shen Qiling, Peng Yongjun, Li Jian, Li Sheng, He Peng, Jiang Zheng, Que Yukang, Cao Kun, Hu Bo, Hu Yong
Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
Front Oncol. 2022 Jun 30;12:935059. doi: 10.3389/fonc.2022.935059. eCollection 2022.
Reconstruction of pelvis girdle stability after tumor-induced hemipelvectomy remains challenging. We surgically treated 13 patients with custom-made, three-dimensional printed hemipelvic prostheses. We aim to identify the preliminary outcomes for patients who have been managed with more mixed regions of prosthetic pelvic reconstruction and the feasibility of two reconstructive systems.
Seven male patients and 6 female patients treated at our center between January 2019 and May 2021 were included. There were 11 primary sarcomas and 2 solitary bone metastases. After en bloc tumor resection, two types of personalized, three-dimensional printed prostheses were fixed to restore the stability and rebuild the load transfer. The position of the reconstructed hemipelvis was evaluated on an anteroposterior plain radiograph. The complications and outcomes were traced. One amputation specimen was discovered through histological analysis of the porous structure.
The operative duration was 467 ± 144 min, and the blood loss was 3,119 ± 662 ml. During a follow-up of 22.4 ± 8.5 months, two patients had delayed wound healing and one had a second-stage flap transfer. One patient with osteosarcoma died of pulmonary metastasis 27 months after surgery. Two patients with marginal resection suffered from local recurrence and had extra surgeries. One patient had traumatic hip dislocation 2 months after surgery and manipulative reduction was performed. The acetabular inclination of the affected side was 42.2 ± 4.3°, compared with 42.1 ± 3.9° on the contralateral side. The horizontal distance between the center of the femoral head and the middle vertical line was 10.4 ± 0.6 cm, while the reconstructed side was 9.8 ± 0.8 cm. No significant difference in acetabular position after surgery was found ( > 0.05). The amputation specimen harvested from one patient with local recurrence demonstrated bone and soft tissue ingrowth within the three-dimensional printed trabecular structure. Walking ability was preserved in all patients who are still alive and no prosthesis-related complications occurred. The MSTS score was 22.0 ± 3.7.
Both types of custom-made, three-dimensional printed prostheses manifested excellent precision, mechanical stability, and promising functional rehabilitation. The porous structure exhibited favorable histocompatibility to facilitate the ingrowth of bone and soft tissue.
肿瘤诱发的半骨盆切除术后骨盆带稳定性的重建仍然具有挑战性。我们采用定制的三维打印半骨盆假体对13例患者进行了手术治疗。我们旨在确定接受更多混合区域假体骨盆重建患者的初步治疗效果以及两种重建系统的可行性。
纳入2019年1月至2021年5月在我们中心接受治疗的7例男性患者和6例女性患者。其中有11例原发性肉瘤和2例孤立性骨转移瘤。整块肿瘤切除后，固定两种类型的个性化三维打印假体以恢复稳定性并重建负荷传递。在前后位X线平片上评估重建半骨盆的位置。追踪并发症和治疗效果。通过对多孔结构的组织学分析发现了一个截肢标本。
手术时间为467±144分钟，失血量为3119±662毫升。在22.4±8.5个月的随访期间，2例患者伤口愈合延迟，1例患者进行了二期皮瓣转移。1例骨肉瘤患者术后27个月死于肺转移。2例边缘性切除患者出现局部复发并接受了额外手术。1例患者术后2个月发生创伤性髋关节脱位并进行了手法复位。患侧髋臼倾斜度为42.2±4.3°，对侧为42.1±3.9°。股骨头中心与中垂线之间的水平距离，健侧为10.4±0.6厘米，重建侧为9.8±0.8厘米。术后髋臼位置无显著差异（P>0.05）。从1例局部复发患者获取的截肢标本显示三维打印小梁结构内有骨和软组织长入。所有存活患者的行走能力均得以保留，未发生与假体相关的并发症。肌肉骨骼肿瘤协会（MSTS）评分为22.0±3.7。
两种定制的三维打印假体均表现出出色的精度、机械稳定性和良好的功能康复前景。多孔结构表现出良好的组织相容性，有利于骨和软组织长入。
