Xie Mengzhang, Gong Taojun, Wang Yitian, Li Zhuangzhuang, Zhang Yuqi, Lu Minxun, Luo Yi, Min Li, Tu Chongqi, Zhou Yong
Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China.
Front Oncol. 2024 Aug 29;14:1380508. doi: 10.3389/fonc.2024.1380508. eCollection 2024.
Involvement of the distal fibula by alveolar soft-part sarcoma is rare. Extensive resection or amputation may be needed; however, distal fibula resection can disrupt foot and ankle biomechanics, leading to ankle joint instability. Reports on joint preservation for maintaining optimal ankle joint function are scarce. Computer-aided design and individualized three-dimensional (3D)-printed uncemented implants represent an evolving solution for reconstructing the distal fibula.
A 34-year-old woman was diagnosed with alveolar soft-part sarcoma in the right lower leg involving the cortical bone of the fibula. After anlotinib treatment, the tumor size decreased, and the tumor response rate was a partial response (PR); however, the patient continued to experience adverse reactions. With multiple disciplinary team discussions, surgical resection was deemed appropriate. Due to the extensive defect and ankle joint instability after resection, a custom-made 3D-printed prosthesis was designed and fabricated to reconstruct the defect, preserving the lateral malleolus. During the follow-up, the patient achieved favorable ankle function, and no prosthesis-related complications were observed.
3D-printed personalized uncemented implants constitute a novel approach and method for addressing the reconstruction issues of the distal fibula and ankle joint. Through the personalized design of 3D-printed prostheses, the lateral malleolus can be preserved, ensuring the normal anatomical structure of the ankle joint. They achieve a well-integrated interface between the prosthesis and bone, ensuring satisfactory postoperative function. Additionally, they offer valuable insights for reconstructing distal bone defects near joints in the extremities. However, confirming these findings requires extensive cohort studies.
肺泡软组织肉瘤累及腓骨远端较为罕见。可能需要进行广泛切除或截肢；然而，腓骨远端切除会破坏足踝生物力学，导致踝关节不稳定。关于保留关节以维持最佳踝关节功能的报道很少。计算机辅助设计和个性化三维（3D）打印非骨水泥植入物是一种用于重建腓骨远端的不断发展的解决方案。
一名34岁女性被诊断为右小腿肺泡软组织肉瘤，累及腓骨皮质骨。安罗替尼治疗后，肿瘤大小减小，肿瘤反应率为部分缓解（PR）；然而，患者继续出现不良反应。经多学科团队讨论，认为手术切除是合适的。由于切除后存在广泛缺损和踝关节不稳定，设计并制作了定制的3D打印假体来重建缺损，保留外踝。随访期间，患者踝关节功能良好，未观察到与假体相关的并发症。
3D打印个性化非骨水泥植入物是解决腓骨远端和踝关节重建问题的一种新方法。通过3D打印假体的个性化设计，可以保留外踝，确保踝关节的正常解剖结构。它们在假体与骨之间实现了良好的整合界面，确保了满意的术后功能。此外，它们为重建四肢关节附近的远端骨缺损提供了有价值的见解。然而，要证实这些发现需要进行广泛的队列研究。
