Paulmier Amaury, Raad Mathieu, Verhelle Charles-Edouard, Paul Laurent, Docquier Pierre-Louis
Cliniques Universitaires Saint-Luc, Service de Chirurgie Orthopédique et Traumatologique, 10,Avenue Hippocrate, Bruxelles B-1200, Belgium.
3D-Side, Rue André Dumont, Mont-Saint-Guibert 5-1435, Belgium.
Sarcoma. 2022 Oct 31;2022:7005629. doi: 10.1155/2022/7005629. eCollection 2022.
For pediatric malignant bone tumors located in the limbs, limb salvage surgery is the gold standard, but it requires adequate resection margins to avoid local recurrence. Primitive bone sarcomas of the forearm (radius or ulna) are very rare and the reconstruction remains challenging. We describe a method to ensure minimal but adequate resection bone margins with precision in four consecutive patients with primitive bone sarcomas of the forearm. During the preoperative planning, magnetic resonance imaging (MRI) was used to delineate the tumor and the tumor volume was transferred to computerized tomography (CT) by image fusion. A patient-specific instrument (PSI) was manufactured by 3D printing to allow the surgeon to perform the surgical cuts precisely according to the preoperative planning. The first PSI was used for the resection of the tumor, which adopted a unique position at the bony surface. A second PSI was intended for the cutting of the bone allograft so that it fitted perfectly with the bone defect. In all four cases, the safe margin obtained into the bone was free of tumor (R0: microscopically margin-negative resection). The functional result was very good in all four patients. This limb salvage surgical technique can be applied in forearm bone sarcoma and improves surgical precision while maintaining satisfactory local tumor control. It can also reduce the surgical time and allow a stable osteosynthesis.
对于位于四肢的小儿恶性骨肿瘤，保肢手术是金标准，但需要足够的切除边缘以避免局部复发。前臂（桡骨或尺骨）的原始骨肉瘤非常罕见，重建仍然具有挑战性。我们描述了一种方法，用于在连续4例前臂原始骨肉瘤患者中精确确保最小但足够的切除骨边缘。在术前规划期间，使用磁共振成像（MRI）描绘肿瘤，并通过图像融合将肿瘤体积转移到计算机断层扫描（CT）。通过3D打印制造定制患者器械（PSI），使外科医生能够根据术前规划精确进行手术切口。第一个PSI用于切除肿瘤，其在骨表面采用独特位置。第二个PSI用于切割骨移植体，使其与骨缺损完美匹配。在所有4例病例中，骨内获得的安全边缘均无肿瘤（R0：显微镜下切缘阴性切除）。所有4例患者的功能结果都非常好。这种保肢手术技术可应用于前臂骨肉瘤，提高手术精度，同时保持令人满意的局部肿瘤控制。它还可以减少手术时间并实现稳定的骨合成。
