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[胫骨远端肿瘤切除术后假体重建应用进展:一项系统评价]

[Advances in the application of prosthetic reconstruction after tumor resection of the distal tibia:a systematic review].

作者信息

Xiang H B, Yunus Akbar, Tian Z, Chen J T, Yadikan Yashengjiang

机构信息

Department of Bone Tumor, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China.

出版信息

Zhonghua Wai Ke Za Zhi. 2023 Dec 1;61(12):1130-1134. doi: 10.3760/cma.j.cn112139-20230510-00200.

Abstract

The limited coverage of soft tissue and complex biomechanical factors make resection and reconstruction of distal tibial tumors extremely challenging. Megaprosthesis can provide good mechanical strength for tumor en bloc resection, but there are many postoperative complications, and the problems of insufficient soft tissue coverage and postoperative ankle instability must be solved. The development of three-dimensional digital technology may provide a new treatment strategy for distal tibial reconstruction. Compared to ankle joint preservation endoprostheses, the rapid osseointegration effect of three dimensional-printed megaprosthesis with ankle arthrodesis provides better ankle joint stability and postoperative function. In addition, the three dimensional-printed megaprosthesis may improve complications such as insufficient soft tissue coverage and talus collapse by reducing the circumference of the prosthesis and matching it with the talus through personalized design. Of course, there are few research reports on distal tibial prostheses, and the safety of three dimensional-printed megaprosthesis with ankle arthrodesis needs to be confirmed through extensive long-term follow-up studies. The selection of proximal and distal fixation methods for prostheses needs to be explored in future research.

摘要

软组织覆盖范围有限以及复杂的生物力学因素使得胫骨远端肿瘤的切除与重建极具挑战性。人工关节假体可为肿瘤整块切除提供良好的机械强度,但术后并发症众多,必须解决软组织覆盖不足和术后踝关节不稳定的问题。三维数字技术的发展可能为胫骨远端重建提供一种新的治疗策略。与保留踝关节的假体相比,三维打印的带踝关节融合的人工关节假体的快速骨整合效果可提供更好的踝关节稳定性和术后功能。此外,三维打印的人工关节假体可通过减小假体周长并通过个性化设计使其与距骨匹配,来改善软组织覆盖不足和距骨塌陷等并发症。当然,关于胫骨远端假体的研究报道较少,三维打印的带踝关节融合的人工关节假体的安全性需要通过广泛的长期随访研究来证实。假体近端和远端固定方法的选择有待未来研究探索。

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