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肘恶性肿瘤切除及 3D 打印技术辅助个体化重建: 1 例报告。

Resection for malignant tumors in the elbow and individualized reconstruction under assistance of 3D printing technology: A case report.

机构信息

Department of Orthopedic Oncology, Yantaishan Hospital, Yantai, Shandong, China.

Yantai Key Laboratory for Repair and Reconstruction of Bone & Joint, Yantai, Shandong, China.

出版信息

Medicine (Baltimore). 2023 Sep 1;102(35):e34854. doi: 10.1097/MD.0000000000034854.

Abstract

RATIONALE

With a high failure rate and multiple postoperative complications, the resection for tumors in the elbow and reconstruction present a formidable challenge to orthopedic surgeons. The maturation of 3-dimension (3D) printing technology has facilitated the preoperative design, intraoperative navigation, and reconstruction of bone defects in patients with complex malignant tumors of the elbow joint. In order to improve prognosis, we explored a method of tumor resection and elbow reconstruction aided by 3D printing technology in this research.

PATIENT CONCERNS

The patient underwent nephrectomy for clear cell carcinoma of the left kidney 3 years ago. Six months ago, the patient presented with limited movement and lateral tenderness in the right elbow joint. The tumor puncture biopsy demonstrated renal clear cell carcinoma metastasis.

DIAGNOSES

Renal clear cell carcinoma with distal humerus bone metastasis.

INTERVENTIONS

Thin-layer CT scan data of the patient was acquired, and a 3D reconstruction of both upper limb bones and joints was conducted, followed by a simulation of diseased tissue excision. According to the model, individualized osteotomy guidelines and elbow prostheses were designed and manufactured. Then, prior to the completion of the actual operation, a simulation of the preoperative phase was performed.

OUTCOMES

The operation was completed without incident. At the 1-, 3-, and 6-month postoperative examinations, both the position and mobility of the prosthesis were found to be satisfactory, and no complications were observed. The hospital for special surgery score and mayo elbow performance score scores increased in comparison to the preoperative period.

LESSONS

For patients with complex tumors in the elbow joint, 3D printing technology may assist in the precise excision of the tumor and provide an individualized elbow joint prosthesis that is more precise and effective than traditional surgery. It can accomplish a satisfactory treatment effect for patients when combined with early postoperative scientific rehabilitation training, so it is a method worth promoting.

摘要

背景

肘部肿瘤的切除和重建对骨科医生来说是一个巨大的挑战,因为其具有高失败率和多种术后并发症。三维(3D)打印技术的成熟为肘部关节复杂恶性肿瘤患者的术前设计、术中导航和骨缺损重建提供了便利。为了提高预后,我们在这项研究中探索了一种 3D 打印技术辅助下的肿瘤切除和肘部重建方法。

患者关注

患者 3 年前因左肾透明细胞癌行肾切除术。6 个月前,患者出现右肘关节活动受限和外侧压痛。肿瘤穿刺活检显示为肾透明细胞癌转移。

诊断

肾透明细胞癌伴肱骨远端骨转移。

干预措施

获取患者的薄层 CT 扫描数据,并进行上下肢骨骼和关节的 3D 重建,然后模拟病变组织切除。根据模型,设计和制造个体化截骨指南和肘部假体。然后,在实际手术完成之前,进行术前模拟。

结果

手术过程顺利。术后 1、3 和 6 个月检查时,假体的位置和活动度均令人满意,未观察到并发症。与术前相比,特种外科医院评分和 Mayo 肘关节功能评分均有所增加。

经验教训

对于肘部复杂肿瘤的患者,3D 打印技术可辅助肿瘤的精确切除,并提供比传统手术更精确、更有效的个体化肘关节假体。结合术后早期科学康复训练,可达到满意的治疗效果,是一种值得推广的方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d4bc/10476851/cfdad70fc019/medi-102-e34854-g001.jpg

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