3D打印定制半骨盆假体置换治疗原发性髋臼周围恶性肿瘤的疗效评估

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摘要目的阐述3D打印定制半骨盆假体的术前个性化规划和手术操作，评价并讨论髋臼周围原发恶性肿瘤切除后假体重建的短期疗效。方法收集2018年2月至2019年2月共22例髋臼周围原发恶性肿瘤并接受3D打印定制假体半骨盆置换术患者资料。男10例，女12例；年龄31~76岁，平均(53.64±10.55)岁。根据Enneking骨盆肿瘤分区，其中累及骨盆Ⅰ、Ⅱ区5例，累及骨盆Ⅱ、Ⅲ区10例，累及骨盆Ⅰ、Ⅱ、Ⅲ区7例。普通型骨肉瘤12例，毛细血管扩张型骨肉瘤3例，软骨肉瘤6例，尤文氏肉瘤1例。所有患者术前均无肿瘤远处转移。术前通过薄层CT数据进行3D建模用于确定肿瘤边界、设计手术导板和定制假体。以Harris髋关节功能评分及肌肉骨骼肿瘤协会评分(musculoskeletal tumor society，MSTS)进行评估，并记录肿瘤学预后及并发症。通过影像学评估双下肢长度、髋臼外展角、髋臼前倾角、髋臼偏心距等。结果所有患者按术前设计重建并进行R0切除。9例患者保留了髂前下棘，无需进行股直肌重建；13例患者进行了股直肌重建；臀大肌、髂腰肌、缝匠肌均重建良好。平均手术时间(414.22±89.13)min，术中出血量(2 682.22±1 909.93)mL。随访时间20~27个月，平均随访时间(23.78±2.54)个月。末次随访时，所有病例均获得良好的骨整合，术后下肢长度、髋臼高度、承重力臂与健侧相比差异无统计学意义(P＞0.05)；术后髋臼偏心距、髋臼外展角、髋臼前倾角与术前相比差异无统计学意义(P＞0.05)。术后Harris评分、MSTS评分与术前相比差异具有统计学意义(P＜0.05)。术后4例患者出现了切口感染，5例患者切口周围脂肪坏死引起伤口延迟愈合，经治疗后痊愈。末次随访未见肿瘤复发、深部感染、假体脱位、螺钉断裂等并发症。结论术前个性化设计3D打印定制半骨盆假体治疗髋关节周围原发恶性肿瘤效果显著，是恶性肿瘤切除后骨盆重建的可靠方法。

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	张强
	杜俊炜
	戴志兵
	武峻申
	江仁兵 *

关键词 ： 3D打印, 假体置入, 骨盆, 髋臼, 恶性肿瘤

Abstract：Objective To describe the preoperative personalized planning and surgical operation of 3D-printed customized hemipelvic prosthesis，and to evaluate and discuss the short-term efficacy of prosthesis reconstruction after resection of periacetabular primary malignant tumors.Methods From February 2018 to February 2019，a total of 22 patients with periacetabular primary malignant tumors who underwent 3D-printed custom-made hemipelvic prosthesis reconstruction in our center were collected.There were 10 males and 12 females.The age ranged from 31 to 76 years，with an average of (53.64±10.55)years.According to Enneking pelvic tumor division，there were 5 patients with pelvic area Ⅰ and Ⅱ involvement，10 patients with pelvic area Ⅱ and Ⅲ involvement and 7 patients with pelvic area Ⅰ，Ⅱ and Ⅲ involvement.There were included 12 conventional osteosarcoma，3 telangiectatic osteosarcoma，6 chondr osarcoma，and 1 ewing’s sarcoma.All patients had no distant tumor metastasis.Preoperative 3D modeling by thin-section CT data was used to determine the tumor-free resection margin，design the osteotomy guide，and customize prosthesis.Harris and musculoskeletal tumor society(MSTS) functional scoring were used for evaluation，oncology prognosis and complications were recorded.X-ray was used to evaluate the length of lower limb，acetabular abduction angle，anteversion angle，acetabular eccentricity，et al.Results R0 resection and precise reconstruction were performed in all patients.9 patients had preservation of the anterior inferior iliac spine without rectus reconstruction，and 13 patients had rectus reconstruction.Gluteus maximus，iliopsoas，sartorius and rectus femoris were all well reconstructed.The mean operative time was (414.22±89.13)min，and the mean intraoperative blood loss was (2 682.22±1 909.93)mL.The followup time ranged from 20 to 27 months，with an average of (23.78±2.54) months.At the final follow-up，all patients achieved good osseointegration.There was no significant difference in postoperative lower limb length，acetabular height，and bodyweight moment arm compared with the healthy side(P＞0.05).There was no significant difference in postoperative acetabular eccentricity，abduction angle，and anteversion angle compared with the preoperative(P＞0.05).Harris and MSTS scores were significantly improved after operation (P＜0.05).4 patients had incision infection and 5 had delayed wound healing due to fat necrosis，which were cured after treatment.The average follow-up time was 23.78 months.No tumor recurrence，deep infection，prosthesis dislocation，screw break，or other complications happened. Conclusion Preoperative personalized design of 3D-printed customized hemipelvic prosthesis is effective in the treatment of primary malignant tumors around the acetabulum and is a reliable method for reconstruction after resection of malignant tumors.

Key words： 3D-printed prosthesis implantation pelvis acetabulu malignant tumor

通讯作者: 江仁兵

作者简介: 张强(1994－ )，男，医师，新疆医科大学附属肿瘤医院骨与软组织科，1178125880@qq.com。

引用本文:

张强，杜俊炜，戴志兵，武峻申，江仁兵 *. 3D打印定制半骨盆假体置换治疗原发性髋臼周围恶性肿瘤的疗效评估[J]. 实用骨科杂志, 2022, 28(3): 203-208.
Zhang Qiang，Du Junwei，Dai Zhibing，Wu Junshen，Jiang Renbing *. The Outcomes of Three Dimensional-printed Custom-made Hemipelvic Prosthesis Replacement for Primary Malignancies Involving the Acetabulum. sygkzz, 2022, 28(3): 203-208.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2022/V28/I3/203

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