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Abstract：
BACKGROUND: Talar malignant tumor is extremely rare. Currently, there are several alternative management options for talus malignant tumor including below-knee amputation, tibio-calcaneal arthrodesis, and homogenous bone transplant while their shortcomings limited the clinical application. Three-dimensional (3D) printed total talus prosthesis in talus lesion was reported as a useful method to reconstruct talus, however, most researches are case reports and its clinical effect remains unclear. Therefore, the current study was to explore the application of 3D printed custom-made modular prosthesis in talus malignant tumor.
METHODS: We retrospectively analyzed the patients who received the 3D printed custom-made modular prosthesis treatment due to talus malignant tumor in our hospital from February 2016 to December 2021. The patient\'s clinical data such as oncology outcome, operation time, and volume of blood loss were recorded. The limb function was evaluated with the Musculoskeletal Tumor Society 93 (MSTS-93) score, The American Orthopedic Foot and Ankle Society (AOFAS) score; the ankle joint ranges of motion as well as the leg length discrepancy were evaluated. Plain radiography and Tomosynthesis-Shimadzu Metal Artefact Reduction Technology (T-SMART) were used to evaluate the position of prosthesis and the osseointegration. Postoperative complications were recorded.
RESULTS: The average patients\' age and the follow-up period were respectively 31.5 ± 13.1 years; and 54.8 months (range 26-72). The medium operation time was 2.4 ± 0.5 h; the intraoperative blood loss was 131.7 ± 121.4 ml. The mean MSTS-93 and AOFAS score was 26.8 and 88.5 respectively. The average plantar flexion, dorsiflexion, varus, and valgus were 32.5, 9.2, 10.8, and 5.8 degree respectively. One patient had delayed postoperative wound healing. There was no leg length discrepancy observed in any patient and good osseointegration was observed on the interface between the bone and talus prosthesis in all subjects.
CONCLUSIONS: The modular structure of the prosthesis developed in this study seems to be convenient for prosthesis implantation and screws distribution. And the combination of solid and porous structure improves the initial stability and promotes bone integration. Therefore, 3D printed custom-made modular talus prosthesis could be an alternative option for talus reconstruction in talus malignant tumor patients.
METHODS: We retrospectively analyzed the patients who received the 3D printed custom-made modular prosthesis treatment due to talus malignant tumor in our hospital from February 2016 to December 2021. The patient\'s clinical data such as oncology outcome, operation time, and volume of blood loss were recorded. The limb function was evaluated with the Musculoskeletal Tumor Society 93 (MSTS-93) score, The American Orthopedic Foot and Ankle Society (AOFAS) score; the ankle joint ranges of motion as well as the leg length discrepancy were evaluated. Plain radiography and Tomosynthesis-Shimadzu Metal Artefact Reduction Technology (T-SMART) were used to evaluate the position of prosthesis and the osseointegration. Postoperative complications were recorded.
RESULTS: The average patients\' age and the follow-up period were respectively 31.5 ± 13.1 years; and 54.8 months (range 26-72). The medium operation time was 2.4 ± 0.5 h; the intraoperative blood loss was 131.7 ± 121.4 ml. The mean MSTS-93 and AOFAS score was 26.8 and 88.5 respectively. The average plantar flexion, dorsiflexion, varus, and valgus were 32.5, 9.2, 10.8, and 5.8 degree respectively. One patient had delayed postoperative wound healing. There was no leg length discrepancy observed in any patient and good osseointegration was observed on the interface between the bone and talus prosthesis in all subjects.
CONCLUSIONS: The modular structure of the prosthesis developed in this study seems to be convenient for prosthesis implantation and screws distribution. And the combination of solid and porous structure improves the initial stability and promotes bone integration. Therefore, 3D printed custom-made modular talus prosthesis could be an alternative option for talus reconstruction in talus malignant tumor patients.
摘要：
背景：距骨恶性肿瘤极为罕见。目前,距骨恶性肿瘤有几种替代治疗方案，包括膝下截肢，胫骨-跟骨关节固定术,同质骨移植的缺点限制了其临床应用。据报道，距骨病变中的三维（3D）打印的全距骨假体是重建距骨的有用方法，然而,大多数研究是病例报告，其临床效果尚不清楚。因此,本研究旨在探索3D打印定制模块化假体在距骨恶性肿瘤中的应用。
方法：回顾性分析2016年2月至2021年12月因距骨恶性肿瘤而接受3D打印定制模块化假体治疗的患者。患者的临床数据，如肿瘤学结果，操作时间,并记录失血量。用肌肉骨骼肿瘤学会93（MSTS-93）评分评估肢体功能，美国骨科足踝协会（AOFAS）评分；评估了踝关节的活动范围以及腿长差异。X线平片和断层合成-岛津金属伪影减少技术（T-SMART）用于评估假体的位置和骨整合。记录术后并发症。
结果：患者的平均年龄和随访时间分别为31.5±13.1岁和54.8个月（范围26-72）。中期手术时间2.4±0.5h,术中出血量131.7±121.4ml。平均MSTS-93和AOFAS评分分别为26.8和88.5。平均足底屈曲，背屈,varus,外翻分别为32.5、9.2、10.8和5.8度。一名患者术后伤口愈合延迟。在任何患者中都没有观察到腿长度差异，并且在所有受试者的骨和距骨假体之间的界面上都观察到了良好的骨整合。
结论：本研究中开发的假体模块化结构似乎便于假体植入和螺钉分配。固体和多孔结构的结合提高了初始稳定性并促进了骨整合。因此,3D打印定制的模块化距骨假体可能是距骨恶性肿瘤患者距骨重建的替代选择。
方法：回顾性分析2016年2月至2021年12月因距骨恶性肿瘤而接受3D打印定制模块化假体治疗的患者。患者的临床数据，如肿瘤学结果，操作时间,并记录失血量。用肌肉骨骼肿瘤学会93（MSTS-93）评分评估肢体功能，美国骨科足踝协会（AOFAS）评分；评估了踝关节的活动范围以及腿长差异。X线平片和断层合成-岛津金属伪影减少技术（T-SMART）用于评估假体的位置和骨整合。记录术后并发症。
结果：患者的平均年龄和随访时间分别为31.5±13.1岁和54.8个月（范围26-72）。中期手术时间2.4±0.5h,术中出血量131.7±121.4ml。平均MSTS-93和AOFAS评分分别为26.8和88.5。平均足底屈曲，背屈,varus,外翻分别为32.5、9.2、10.8和5.8度。一名患者术后伤口愈合延迟。在任何患者中都没有观察到腿长度差异，并且在所有受试者的骨和距骨假体之间的界面上都观察到了良好的骨整合。
结论：本研究中开发的假体模块化结构似乎便于假体植入和螺钉分配。固体和多孔结构的结合提高了初始稳定性并促进了骨整合。因此,3D打印定制的模块化距骨假体可能是距骨恶性肿瘤患者距骨重建的替代选择。
