APC重建技术联合3D打印个性化非限制性全膝置换在胫骨上段恶性肿瘤中的应用
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摘要
目的探究同种异体骨-假体复合物(APC)重建技术联合3D打印个性化非限制性全膝置换(TKR)治疗胫骨上段恶性肿瘤的临床疗效。方法回顾性分析南部战区总医院2005年1月至2015年1月收治的25例胫骨上段恶性肿瘤患者的临床资料。根据术式不同分为个性化手术组和常规手术组,个性化手术组12例,采用APC重建技术联合3D打印个性化非限制性TKR治疗;常规手术组13例,采用常规手术+铰链式假体治疗。比较两组患者瘤段切除长度、术中出血量、手术时间以及术后双下肢长度差、力线偏移和并发症发生情况,记录两组随访期间肿瘤复发率、膝关节活动度以及骨与软组织肿瘤学会(MSTS)膝关节功能评分。结果两组患者瘤段切除长度、术中出血量、并发症发生率及肿瘤复发率比较,差异无统计学意义(P>0.05)。个性化手术组手术时间、术后肢体长度差和力线偏移度明显少于常规手术组,术后1、3年膝关节主动屈曲度及MSTS膝关节功能评分明显高于常规手术组(P <0.05)。结论与常规手术联合铰链式假体相比,APC重建技术联合个性化非限制性TKR治疗胫骨上段恶性肿瘤解剖匹配精度高,节省手术时间,能提供良好的术后功能,临床效果满意。
Objective To explore the clinical efficacy of allograft-prosthetic composite(APC) reconstruction technique combined with 3D printing personalized non-restrictive total knee replacement(TKR) for upper tibial malignant tumors.Methods Clinical data of 25 patients with upper tibial malignant tumor treated in GeneralHospital of Southern Theater Command from January 2005 to January 2015 were analyzed retrospectively.According to different surgical approaches,the patients were divided into personalized surgery(n = 12) and routine surgery groups(n = 13).Patients in personalized surgery group were performed APC reconstruction technique combined with 3D printing personalized non-restrictive TKR,while patients in routine surgery group were treated with conventional procedure with hinged prosthesis.Tumor resection length,estimate intraoperative bleeding volume,operation time,postoperative length difference between lower limbs and limb alignment deviation,postoperative complications were compared between two groups,tumor recurrence,range of motion(ROM) of knee joint and Musculoskeletal Tumor Society(MSTS) knee joint function scores during the follow-up in two groups were also recorded.Results There were no significant differences in tumor resection length,estimate intraoperative bleeding volume,incidence of complications and tumor recurrence incidence(P >0.05).Operation time,postoperative limb length difference and alignment deviation in personalized surgery group were lower than those in routine surgery group,knee joint active ROM and MSTS function scores at 1,3 years postoperatively were higher than those in routine surgery group(P <0.05).Conclusions For patients with upper tibial malignant tumor,APC reconstruction method combined with personalized non-restrictive TKR could obtain satisfactory clinical efficacy with the advantages of high anatomical matching accuracy,less operation time,good postoperative function recovery when compared with conventional procedure + hinged prosthesis.
Objective To explore the clinical efficacy of allograft-prosthetic composite(APC) reconstruction technique combined with 3D printing personalized non-restrictive total knee replacement(TKR) for upper tibial malignant tumors.Methods Clinical data of 25 patients with upper tibial malignant tumor treated in GeneralHospital of Southern Theater Command from January 2005 to January 2015 were analyzed retrospectively.According to different surgical approaches,the patients were divided into personalized surgery(n = 12) and routine surgery groups(n = 13).Patients in personalized surgery group were performed APC reconstruction technique combined with 3D printing personalized non-restrictive TKR,while patients in routine surgery group were treated with conventional procedure with hinged prosthesis.Tumor resection length,estimate intraoperative bleeding volume,operation time,postoperative length difference between lower limbs and limb alignment deviation,postoperative complications were compared between two groups,tumor recurrence,range of motion(ROM) of knee joint and Musculoskeletal Tumor Society(MSTS) knee joint function scores during the follow-up in two groups were also recorded.Results There were no significant differences in tumor resection length,estimate intraoperative bleeding volume,incidence of complications and tumor recurrence incidence(P >0.05).Operation time,postoperative limb length difference and alignment deviation in personalized surgery group were lower than those in routine surgery group,knee joint active ROM and MSTS function scores at 1,3 years postoperatively were higher than those in routine surgery group(P <0.05).Conclusions For patients with upper tibial malignant tumor,APC reconstruction method combined with personalized non-restrictive TKR could obtain satisfactory clinical efficacy with the advantages of high anatomical matching accuracy,less operation time,good postoperative function recovery when compared with conventional procedure + hinged prosthesis.
引文
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[22]姜鹏翔,李建民.恶性骨肿瘤保肢手术并发症的原因及防治[J].临床骨科杂志,2005,8(2):116-120.
[23]黄俊琪,毕文志,韩纲,等.胫骨近端肿瘤假体置换术后伸膝装置重建病例报道并文献复习[J].中国骨与关节杂志,2017,6(3):210-215.
[24]Foo LS,Hardes J,Henrichs M,et al.Surgical difficulties encountered with use of modular endoprosthesis for limb preserving salvage of failed allograft reconstruction after malignant tumor resection[J].J Arthroplasty,2011,26(5):744-750.
[2]Ravindranath VS,Sastri VR.Biological reconstruction of the knee joint in a case of giant cell tumor of the tibia of 15yrs followup:a case report[J].J Orthop Case Rep,2014,4(4):54-56.
[3]Enneking WF,Spanier SS,Goodman MA,et al.A system for the surgical staging of musculoskeletal sarcoma[J].Clin Orthop Relat Res,1980(153):106-120.
[4]Myles PS,Troedel S,Boquest M,et al.The pain visual analog scale:is it linear or nonlinear?[J].Anesth Analg,1999,89(6):1517-1520.
[5]Enneking WF,Dunham W,Gebhardt MC,et al.A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system[J].Clin Orthop Relat Res,1993(286):241-246.
[6]李栋,马焕芝,张伟,等.肿瘤型铰链式人工膝关节置换术后假体相关并发症分析[J].中国修复重建外科杂志,2015,29(8):936-940.
[7]Kinkel S,Lehner B,Kleinhans JA,et al.Medium to longterm results after reconstruction of bone defects at the knee with tumor endoprostheses[J].J Surg Oncol,2010,101(2):166-169.
[8]Biau DJ,Larousserie F,Thévenin F,et al.Results of 32allograft-prosthesis composite reconstructions of the proximal femur[J].Clin Orthop Relat Res,2010,468(3):834-845.
[9]Anract P,Coste J,Vastel L,et al.Proximal femoral reconstruction with megaprosthesis versus allograft prosthesis composite:a comparative study of functional results,complications and longevity in 41 cases[J].Rev Chir Orthop Reparatrice Appar Mot,2000,86(3):278-288.
[10]Gebhardt MC,Flugstad DI,Springfield DS,et al.The use of bone allografts for limb salvage in high-grade extremity osteosarcoma[J].Clin Orthop Relat Res,1991(270):181-196.
[11]Wong KC,Kumta SM.Computer-assisted tumor surgery in malignant bone tumors[J].Clin Orthop Relat Res,2013,471(3):750-761.
[12]Park JW,Kang HG,lim KM,et al.Bone tumor resection guide using three-dimensional printing for limb salvage surgery[J].J Surg Oncol,2018,118(6):898-905.
[13]纪玉清,吴玉仙,李建民,等.3D打印截骨导板在股骨远端骨肉瘤肿瘤切除、假体重建术中的应用[J].中国骨与关节杂志,2018,7(7):547-551.
[14]Ma L,Zhou Y,Zhu Y,et al.3D-printed guiding templates for improved osteosarcoma resection[J].Sci Rep,2016,6:23335.
[15]潘伟,郝永强,严孟宁,等.个体化数字导板结合3D打印技术在旋转铰链型人工膝关节置换术中的应用[J].国际骨科学杂志,2015,36(3):231-234.
[16]黄敏强,丁焕文,陈志源,等.3D打印导航模板辅助个性化非限制性肿瘤型假体重建术治疗膝关节周围恶性骨肿瘤的疗效[J].中国修复重建外科杂志,2016,31(7):815-821.
[17]丁焕文,沈健坚,涂强,等.计算机辅助下膝关节周围肿瘤的精确切除与重建[J].中国骨与关节杂志,2012,1(1):60-67.
[18]So TY,Lam YL,Mak KL.Computer-assisted navigation in bone tumor surgery:seamless workflow model and evolution of technique[J].Clin Orthop Relat Res,2010,468(11):2985-2991.
[19]Wong KC,Kumta SM.Computer-assisted tumor surgery in malignant bone tumors[J].Clin Orthop Relat Res,2013,471(3):750-761.
[20]徐明,郑凯,于秀淳,等.肿瘤型膝关节假体置换治疗胫骨近端骨巨细胞瘤多中心回顾性研究[J].中国骨与关节杂志,2017,6(2):87-91.
[21]Wang F,Zhu J,Peng X,et al.The application of 3D printed surgical guides in resection and reconstruction of malignant bone tumor[J].Oncol Lett,2017,14(4):4581-4584.
[22]姜鹏翔,李建民.恶性骨肿瘤保肢手术并发症的原因及防治[J].临床骨科杂志,2005,8(2):116-120.
[23]黄俊琪,毕文志,韩纲,等.胫骨近端肿瘤假体置换术后伸膝装置重建病例报道并文献复习[J].中国骨与关节杂志,2017,6(3):210-215.
[24]Foo LS,Hardes J,Henrichs M,et al.Surgical difficulties encountered with use of modular endoprosthesis for limb preserving salvage of failed allograft reconstruction after malignant tumor resection[J].J Arthroplasty,2011,26(5):744-750.