Department of Orthopeadic, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, School of Engineering Medicine, Beihang University, Beijing, China.
Surg Innov. 2024 Jun;31(3):307-317. doi: 10.1177/15533506241244493. Epub 2024 Apr 12.
Reconstructing bone defects in the upper extremities and restoring their functions poses a significant challenge. In this study, we describe a novel workflow for designing and manufacturing customized bone cement molds using 3D printing technology to reconstruct upper extremity defects after bone tumor resection.
Computer tomography data was acquired from the unaffected upper extremities to create a detachable mold, which can be customized to fit the joint precisely by shaping the bone cement accordingly. Fourteen patients who underwent reconstructive surgery following bone tumor resection in the proximal humerus (13 cases) or distal radius (1 case) between January 2014 and December 2022 were retrospectively evaluated. The medical records of this case series were reviewed for the demographic, radiological, and operative data. Metastasis, local recurrence, and complication were also reviewed. Additionally, Musculoskeletal Tumor Society Score (MSTS) and Visual Analogue Scale (VAS) were used to assess clinical outcomes.
The mean follow-up period was 49.36 ± 15.18 months (range, 27-82 months). At the end of follow-up, there were no cases of metastasis or recurrence, and patients did not experience complications such as infection, dislocation, or implant loosening. Two cases complicated with subluxation (14.3%), and 1 case underwent revision surgery for prosthetic fracture (7.1%). The average MSTS score was 23.2 ± 1.76 (77.4%, range, 66.7%-86.7%), and the postoperative VAS score was 1.86 ± 1.03 (range, 1-4), which was significantly lower than that before surgery (average preoperative VAS score was 5.21 ± 2.00 (range, 2-8)) ( < .001).
Customized 3D molds can be utilized to shape bone cement prostheses, which may serve as a potential alternative for reconstructing the proximal humerus and distal radius following en bloc resection of bone tumors. This reconstruction strategy offers apparent advantages, including precise matching of articular surfaces and comparatively reduced costs.
重建上肢骨缺损并恢复其功能是一项重大挑战。本研究介绍了一种使用 3D 打印技术设计和制造定制骨水泥模具的新方法，用于重建骨肿瘤切除术后上肢缺陷。
从无影响的上肢采集计算机断层扫描数据，以创建可分离的模具，通过相应地塑造骨水泥，可精确定制以贴合关节。回顾性评估了 2014 年 1 月至 2022 年 12 月期间 14 例接受肱骨近端（13 例）或桡骨远端（1 例）骨肿瘤切除后重建手术的患者。对该病例系列的病历进行了回顾，以获取人口统计学、影像学和手术数据。还评估了转移、局部复发和并发症。此外，使用肌肉骨骼肿瘤学会评分（MSTS）和视觉模拟量表（VAS）评估临床结果。
平均随访时间为 49.36 ± 15.18 个月（范围 27-82 个月）。随访结束时，无转移或复发病例，患者未发生感染、脱位或植入物松动等并发症。2 例（14.3%）并发半脱位，1 例（7.1%）因假体骨折行翻修手术。平均 MSTS 评分为 23.2 ± 1.76（77.4%，范围 66.7%-86.7%），术后 VAS 评分为 1.86 ± 1.03（范围 1-4），明显低于术前（平均术前 VAS 评分为 5.21 ± 2.00（范围 2-8））（ <.001）。
定制 3D 模具可用于塑造骨水泥假体，可能成为骨肿瘤整块切除后重建肱骨近端和桡骨远端的潜在替代方法。这种重建策略具有明显的优势，包括关节表面的精确匹配和相对较低的成本。
