Qu Guoxin, Zhang Chunlei, Wang Jiaqiang, Yao Weitao, Wang Xin, Zhang Peng
Department of Orthopedics and Soft Tissue, the Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou Henan, 450008, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2022 Sep 15;36(9):1108-1113. doi: 10.7507/1002-1892.202205015.
To evaluate the feasibility and short-term effectiveness of three-dimensional (3D) printed titanium-alloy prosthesis reconstruction after the distal tibia tumor segment resection.
The clinical data of 6 patients with bone defect after distal tibia tumor segment resection treated with 3D printed titanium-alloy prosthesis reconstruction and tibiotalar joint fusion between January 2020 and December 2021 were retrospectively analyzed. There were 2 males and 4 females; the age ranged from 12 to 35 years, with an average of 18.5 years. Among them, 4 cases were osteosarcoma, 1 case was Ewing sarcoma, and 1 case was giant cell tumor of bone. The Enneking staging was stage ⅡA in 3 cases, stage ⅡB in 2 cases, and stage Ⅲ in 1 case. The disease duration was 2-5 months (mean, 3.2 months). All patients received preoperative neoadjuvant therapy, and patients with osteosarcoma and Ewing sarcoma started chemotherapy at3 weeks after operation. The systemic and local tumor conditions and prosthesis conditions were evaluated regularly after operation. The Musculoskeletal Tumor Society (MSTS) score and the American Orthopaedic Foot and Ankle Society (AOFAS) score were used to evaluate the lower extremity and ankle function.
All patients were followed up 8-26 months, with an average of 15.6 months. There was no local recurrence and distant metastasis during the follow-up. The ankle joints of 5 cases were all in 90° functional position at last follow-up, and there was no complication such as prosthesis loosening and fracture; the ankle joint fusion was stable, the local bone ingrowth was good, and the daily activities could be completed, but the ankle range of motion was limited and the ankle joint was stiff. The MSTS score ranged from 22 to 26, with an average of 24, and 3 cases were evaluated as excellent and 2 cases were good; the AOFAS score ranged from 71 to 86, with an average of 80.6, and 4 cases were evaluated as good and 1 case was fair. One patient had severe periprosthetic infection at 2 months after operation, resulting in failure of prosthesis implantation, pain in limb movement, and poor ankle function; MSTS score was 12, AOFAS score was 50, and both were evaluated as poor; distraction osteogenesis was performed after removal of prosthesis and infection control, at present, it was still in the process of distraction osteogenesis, and local osteogenesis was acceptable.
Using 3D printed titanium-alloy prosthesis and tibiotalar joint fusion to reconstruct the bone defect after distal tibia tumor segment resection has satisfactory mechanical stability and function, and is one of the effective distal tibial limb salvage methods.
评估三维（3D）打印钛合金假体在胫骨远端肿瘤节段切除术后重建的可行性及短期疗效。
回顾性分析2020年1月至2021年12月采用3D打印钛合金假体重建及胫距关节融合治疗的6例胫骨远端肿瘤节段切除术后骨缺损患者的临床资料。其中男性2例，女性4例；年龄12～35岁，平均18.5岁。其中骨肉瘤4例，尤因肉瘤1例，骨巨细胞瘤1例。Enneking分期：ⅡA期3例，ⅡB期2例，Ⅲ期1例。病程2～5个月（平均3.2个月）。所有患者均接受术前新辅助治疗，骨肉瘤和尤因肉瘤患者术后3周开始化疗。术后定期评估全身及局部肿瘤情况及假体情况。采用肌肉骨骼肿瘤学会（MSTS）评分和美国矫形足踝协会（AOFAS）评分评估下肢及踝关节功能。
所有患者均获随访8～26个月，平均15.6个月。随访期间无局部复发及远处转移。末次随访时5例患者踝关节均处于90°功能位，无假体松动、骨折等并发症；胫距关节融合稳定，局部骨长入良好，可完成日常活动，但踝关节活动度受限，踝关节僵硬。MSTS评分22～26分，平均24分，优3例，良2例；AOFAS评分71～86分，平均80.6分，良4例，可1例。1例患者术后2个月发生严重假体周围感染，导致假体植入失败，肢体活动疼痛，踝关节功能差；MSTS评分12分，AOFAS评分50分，均为差；假体取出及控制感染后行牵张成骨，目前仍在牵张成骨过程中，局部成骨可接受。
采用3D打印钛合金假体及胫距关节融合重建胫骨远端肿瘤节段切除术后骨缺损具有满意的力学稳定性和功能，是有效的胫骨远端肢体挽救方法之一。
