目的:在桡骨远端骨巨细胞瘤(GCTB)整块切除后,使用自体腓骨移植(FA)重建缺损是经典的,但并发症发生率高。我们描述了一种新颖的重建方法,该方法采用了LARS®和3D打印假体(L-P)的合作应用,并研究了它是否可以改善术后结果。
方法:2015年4月至2022年8月,将14例桡骨远端GCTB整块切除术后接受协同L-P重建方法的患者和31例接受FA重建的患者作为本比较研究的两个回顾性队列。L-P组详细阐述了植入物的特性和关键手术技术。术前功能,术中数据,和术后临床,功能,记录并比较两组患者的影像学结局.手腕运动的握力和范围,包括扩展,屈曲,径向偏差,和尺骨偏差,被测量。选择Mayo改良的腕关节和肌肉骨骼肿瘤学会评分来评估腕关节功能和手术功能结果,分别。制作Kaplan-Meier曲线,分析两组患者并发症发生率和植入物生存率的显著差异。
结果:在两组中,所有45例患者均接受了手术,无并发症,平均截骨长度和出血量相似,而L-P组的手术持续时间较短(201.43±22.87minvs.230.16±51.44分钟,P=0.015)。平均随访40.42±18.43个月(范围,14-72个月),两种重建方法均能有效改善术后功能。接受L-P的患者术后改良Mayo腕关节评分较高(81.43±5.49vs.71.13±16.10,P=0.003),肌肉骨骼肿瘤学会评分(27.64±1.34vs.25.06±2.95,P=0.004),和正常侧的握力(68.71%±8.00%vs.57.81%±12.31%,P=0.005)比FA组。更好的手腕伸展(63.21°±8.99°vs.45.32°±14.53°,P<0.001)和屈曲(45.36°±7.90°vs.30.48°±12.07°,在L-P组中也观察到P<0.001)。FA组并发症发生率(29/31,93.55%)明显高于L-P组(1/14,7.14%,P<0.001)。L-P组植入物存活率高于FA组,但差异无统计学意义。
结论:LARS®和3D打印假体的合作应用是重建桡骨远端GCTB整块切除术后肌肉骨骼缺损的有效方法,可以改善功能结果,降低并发症发生率,并促进腕关节的稳定性和运动。
OBJECTIVE: Using a fibula autograft (FA) to reconstruct defects after en bloc resection of giant cell tumor of bone (GCTB) in the distal radius is classic but has high complication rates. We describe a novel reconstruction method employing the cooperative application of LARS® and a 3D-printed prosthesis (L-P) and investigate whether it improves postoperative outcomes.
METHODS: From April 2015 to August 2022, 14 patients who underwent the cooperative L-P reconstruction method after en bloc resection of distal radial GCTBs and 31 patients who received FA reconstruction were enrolled as two retrospective cohorts in this comparative study. The properties of the implants and critical surgical techniques were elaborated in the L-P group. Preoperative function, intraoperative data, and postoperative clinical, functional, and radiographic outcomes of all patients were recorded and compared between the two groups. The grip strength and range of wrist motion, including extension, flexion, radial deviation, and ulnar deviation, were measured. The Mayo modified wrist and Musculoskeletal Tumor Society scores were chosen to assess wrist function and surgical functional outcomes, respectively. Kaplan-Meier curves were generated to analyze the significant differences in complication rates and implant survival between the two groups.
RESULTS: In both groups, all 45 patients underwent the operation without complication with similar average osteotomy lengths and bleeding volumes, while a shorter operative duration was achieved in the L-P group (201.43 ± 22.87 min vs. 230.16 ± 51.44 min, P = 0.015). At a mean follow-up of 40.42 ± 18.43 months (range, 14-72 months), both reconstruction methods effectively ameliorated postoperative function. Patients who received L-P showed higher postoperative modified Mayo wrist scores (81.43 ± 5.49 vs. 71.13 ± 16.10, P = 0.003), Musculoskeletal Tumor Society scores (27.64 ± 1.34 vs. 25.06 ± 2.95, P = 0.004), and grip strength on the normal side (68.71% ± 8.00% vs. 57.81% ± 12.31%, P = 0.005) than the FA group. Better wrist extension (63.21° ± 8.99° vs. 45.32° ± 14.53°, P < 0.001) and flexion (45.36° ± 7.90° vs. 30.48° ± 12.07°, P < 0.001) were also observed in the L-P group. The complication rate was significantly higher in the FA group (29/31, 93.55%) than in the L-P group (1/14 7.14%, P < 0.001). The L-P group showed higher implant survival than the FA group, but the difference was not statistically significant.
CONCLUSIONS: The cooperative application of LARS® and 3D-printed prostheses is an effective modality for reconstructing musculoskeletal defects after en bloc resection of distal radial GCTBs, which can improve functional outcomes, diminish complication rates, and promote wrist joint stability and motion.