Bin Guolong, Liu Bin, Yuan Zhenchao, Tan Jiachang
Department of Bone and Soft Tissue Surgery, Guangxi Medical University Cancer Hospital, Nanning, China.
Front Oncol. 2025 Jun 18;15:1596530. doi: 10.3389/fonc.2025.1596530. eCollection 2025.
The utilization of 3D-printed arthrodesis prostheses represent a viable reconstructive option for patients who are unable to retain the deltoid muscle or axillary nerve following the resection of malignant tumors in the proximal humerus. However, there exists a limited body of literature regarding the application of this prosthetic type. In this study, we assessed the effectiveness of 3D-printed arthrodesis prostheses in the repair and reconstruction of the proximal humerus post-tumor resection. Additionally, we investigated the incidence of postoperative complications and the enhancements associated with the prostheses.
This study retrospectively examined a cohort of 12 patients diagnosed with malignant tumors of the proximal humerus, who underwent reconstruction utilizing 3D-printed arthrodesis prostheses at our institution between January 2020 and December 2022. The design of the prostheses were conducted preoperatively through computer-aided design (CAD) technology, among other methods. Each patient underwent intraoperative resection of the tumor-affected segment followed by reconstruction with the 3D-printed arthrodesis prostheses. Postoperative follow-up assessments were conducted to evaluate the range of motion (ROM) of the shoulder joint, assess shoulder joint functionality, document the occurrence of complications, and analyze potential risk factors associated with these outcomes.
All 12 patients underwent the procedure without complications, with an average operation duration of (172.5 ± 58.9) min (range 130-240 min). The average blood loss recorded was (450.3 ± 118.4) ml (range 200-1000 ml), and the average length of the osteotomy at the proximal humerus was (16.5 ± 1.2) cm (range 15-19 cm). The follow-up period for all patients averaged (26.2 ± 14.5) months (range 12-49 months). At the final follow-up, the average active shoulder joint abduction among the twelve patients was 75.2° ± 12.3°(range 45°-110°), while the average anterior flexion was 70.8° ± 18.4°(range 60°-125°). The average American Shoulder and Elbow Surgeons (ASES) score was 75.2 ± 6.3 points (range 63-90 points), and the Musculoskeletal Tumor Society (MSTS-93) score averaged 22.1 ± 2.5points (range 21-27 points). According to the complication classification system for post-prosthetic reconstruction proposed by Henderson, the group exhibited one case of type I, two cases of type II, two cases of type III, and two cases of type IV complications.
The utilization of 3D-printed arthrodesis prostheses in the repair and reconstruction of malignant tumors in proximal humerus has the potential to enhance postoperative functionality. However, the prevalence of complications associated with these prostheses remains significant. Therefore, there is a pressing need for advancements in both prostheses design and surgical protocols to optimize clinical outcomes.
对于肱骨近端恶性肿瘤切除术后无法保留三角肌或腋神经的患者，3D打印关节固定假体的应用是一种可行的重建选择。然而，关于这种假体类型应用的文献数量有限。在本研究中，我们评估了3D打印关节固定假体在肿瘤切除后肱骨近端修复和重建中的有效性。此外，我们调查了术后并发症的发生率以及与假体相关的改善情况。
本研究回顾性分析了2020年1月至2022年12月期间在我院接受3D打印关节固定假体重建的12例肱骨近端恶性肿瘤患者。假体设计术前通过计算机辅助设计（CAD）技术等方法进行。每位患者术中切除肿瘤累及节段，然后用3D打印关节固定假体进行重建。术后进行随访评估，以评估肩关节活动范围（ROM）、评估肩关节功能、记录并发症的发生情况，并分析与这些结果相关的潜在风险因素。
12例患者均顺利完成手术，无并发症发生，平均手术时间为（172.5±58.9）分钟（范围130 - 240分钟）。记录的平均失血量为（450.3±118.4）毫升（范围200 - 1000毫升），肱骨近端截骨平均长度为（16.5±1.2）厘米（范围15 - 19厘米）。所有患者的随访期平均为（26.2±14.5）个月（范围12 - 49个月）。末次随访时，12例患者肩关节平均主动外展角度为75.2°±12.3°（范围45° - 110°），平均前屈角度为70.8°±18.4°（范围60° - 125°）。美国肩肘外科医师（ASES）平均评分为75.2±6.3分（范围63 - 90分），肌肉骨骼肿瘤学会（MSTS - 93）评分平均为22.1±2.5分（范围21 - 27分）。根据亨德森提出的假体重建后并发症分类系统，该组出现I型并发症1例，II型并发症2例，III型并发症2例，IV型并发症2例。
3D打印关节固定假体在肱骨近端恶性肿瘤的修复和重建中有可能提高术后功能。然而，与这些假体相关的并发症发生率仍然较高。因此，迫切需要在假体设计和手术方案方面取得进展，以优化临床结果。
