Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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)) (P < .001).
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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)) (P < .001).
CONCLUSIONS: 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.
摘要：
背景：重建上肢的骨缺损并恢复其功能是一项重大挑战。在这项研究中,我们描述了一种新颖的工作流程，用于使用3D打印技术设计和制造定制的骨水泥模具，以重建骨肿瘤切除后的上肢缺损。
方法：从未受影响的上肢获取计算机断层摄影数据，以创建可拆卸的模具，可以通过相应地塑造骨水泥来定制以精确地适合关节。回顾性评估2014年1月至2022年12月期间14例肱骨近端（13例）或桡骨远端（1例）骨肿瘤切除后接受重建手术的患者。对这一系列病例的医疗记录进行了人口统计审查，放射学,和操作数据。转移,局部复发,和并发症也进行了审查。此外,肌肉骨骼肿瘤学会评分（MSTS）和视觉模拟评分（VAS）用于评估临床结果。
结果：平均随访期为49.36±15.18个月（范围，27-82个月）。在后续行动结束时，没有转移或复发的病例，患者没有出现感染等并发症，位错,或植入物松动。2例合并半脱位(14.3%),1例假体骨折翻修手术(7.1%)。MSTS平均得分为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),显著低于术前(术前平均VAS评分为5.21±2.00(范围,2-8））（P<.001）。
结论：定制的3D模具可用于成型骨水泥假体，这可能是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，包括关节面的精确匹配和相对降低的成本。
方法：从未受影响的上肢获取计算机断层摄影数据，以创建可拆卸的模具，可以通过相应地塑造骨水泥来定制以精确地适合关节。回顾性评估2014年1月至2022年12月期间14例肱骨近端（13例）或桡骨远端（1例）骨肿瘤切除后接受重建手术的患者。对这一系列病例的医疗记录进行了人口统计审查，放射学,和操作数据。转移,局部复发,和并发症也进行了审查。此外,肌肉骨骼肿瘤学会评分（MSTS）和视觉模拟评分（VAS）用于评估临床结果。
结果：平均随访期为49.36±15.18个月（范围，27-82个月）。在后续行动结束时，没有转移或复发的病例，患者没有出现感染等并发症，位错,或植入物松动。2例合并半脱位(14.3%),1例假体骨折翻修手术(7.1%)。MSTS平均得分为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),显著低于术前(术前平均VAS评分为5.21±2.00(范围,2-8））（P<.001）。
结论：定制的3D模具可用于成型骨水泥假体，这可能是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，包括关节面的精确匹配和相对降低的成本。
