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3D 打印假体重建在骨盆肿瘤切除术后的疗效研究。

Study of the efficacy of 3D-printed prosthetic reconstruction after pelvic tumour resection.

机构信息

Department of Orthopedics, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.

出版信息

J Biomater Appl. 2023 Apr;37(9):1626-1631. doi: 10.1177/08853282231161110. Epub 2023 Feb 27.

Abstract

The purpose of this study is to explore the effect of using 3D printed pelvic prosthesis to reconstruct bone defect after pelvic tumor resection. From June 2018 to October 2021, a total of 10 patients with pelvic tumors underwent pelvic tumor resection and 3D printed customized hemipelvic prosthesis reconstruction in our hospital. Enneking pelvic surgery subdivision method was used to determine the degree of tumor invasion and the site of prosthesis reconstruction. 2 cases in Zone I, 2 cases in Zone II, 3 cases in Zone I + II, 2 cases in Zone II + III and 1 case in Zone I + II + III. Patients had preoperative VAS scores of 6.5 ± 1.3, postoperative VAS scores of 2.2 ± 0.9, preoperative MSTS-93 scores of 9.4 ± 5.3 and postoperative 19.4 ± 5.9( < 0.05), all patients had improvement in pain after surgery; Postoperative complications included joint dislocation in 2 cases, myasthenia caused by Guillain-Barre syndrome in 1 case, delayed wound healing in 3 cases and wound infection in 2 cases. Postoperative wound-related complications and dislocations were associated with the extent of the tumor. Patients with tumor invasion of the iliopsoas and gluteus medius muscles had higher complication rates and worse postoperative MSTS scores ( < 0.05). The patients were followed up for 8 ∼ 28 months. During the follow-up period, 1 case recurred, 4 cases metastasized and 1 case died. All pelvic CTs reviewed 3-6 months after surgery showed good alignment between the 3D printed prosthesis and the bone contact, and tomography showed the growth of trabecular structures into the bone. Overall pain scores decreased and functional scores improved in patients after 3D printed prosthesis replacement for pelvic tumor resection. Long-term bone ingrowth could be seen on the prosthesis-bone contact surface with good stability.

摘要

本研究旨在探讨使用 3D 打印骨盆假体重建骨盆肿瘤切除术后骨缺损的效果。2018 年 6 月至 2021 年 10 月,我院共收治 10 例骨盆肿瘤患者,均行骨盆肿瘤切除及 3D 打印定制半骨盆假体重建。采用 Enneking 骨盆外科亚区法判断肿瘤侵犯程度和假体重建部位,Ⅰ区 2 例,Ⅱ区 2 例,Ⅰ+Ⅱ区 3 例,Ⅱ+Ⅲ区 2 例,Ⅰ+Ⅱ+Ⅲ区 1 例。患者术前 VAS 评分为 6.5±1.3,术后为 2.2±0.9;术前 MSTS-93 评分为 9.4±5.3,术后为 19.4±5.9(<0.05),所有患者术后疼痛均有改善;术后并发症包括关节脱位 2 例,吉兰-巴雷综合征致肌无力 1 例,切口愈合延迟 3 例,切口感染 2 例。术后与伤口相关的并发症和脱位与肿瘤的侵袭程度有关。肿瘤侵犯髂腰肌和臀中肌的患者并发症发生率较高,术后 MSTS 评分较低(<0.05)。患者随访 8~28 个月,随访期间复发 1 例,转移 4 例,死亡 1 例。术后 3~6 个月复查骨盆 CT 均显示 3D 打印假体与骨接触良好,体层摄影术显示小梁结构向骨内生长。所有患者术后总体疼痛评分降低,功能评分提高。在 3D 打印假体置换治疗骨盆肿瘤切除术后,可在假体-骨接触表面观察到长期的骨内生长,假体稳定性良好。

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