目的:由于复杂的解剖结构,骨盆骨肿瘤的切除和随后的骨盆带重建带来了巨大的挑战,承重要求,和重大缺陷。3D打印植入物通过使用定制导向器实现精确切除,改善了骨盆带重建。为不同的骨缺损形态提供量身定制的解决方案,并整合多孔表面结构以促进骨整合。我们的研究旨在评估恶性骨盆肿瘤切除后3D打印半骨盆重建的长期疗效和可行性。
方法:对2017年1月至2022年5月期间使用3D打印定制半骨盆假体进行骨盆带重建的96例原发性盆腔恶性肿瘤患者进行了回顾性回顾。随访时间中位数为48.1±17.9个月(范围,6至76个月)。人口统计数据,影像学检查,手术结果,和肿瘤学评估进行提取和分析。主要终点包括通过肌肉骨骼肿瘤协会(MSTS-93)评分评估的肿瘤结果和功能状态。次要终点包括手术持续时间,术中出血,疼痛控制和并发症。
结果:在96名患者中,70例患者(72.9%)保持无病,15例(15.6%)局部复发,11例(11.4%)死于转移性疾病。术后,功能随着MSTS-93评分从12.2±2.0增加到23.8±3.8而改善。平均手术时间为275.1±94.0min,术中平均出血量为1896.9±801.1ml。疼痛得到了很好的管理,导致VAS评分大幅改善(5.3±1.8至1.4±1.1)。并发症发生在13例(13.5%),包括伤口愈合不良(6.3%),深部假体感染(4.2%),髋关节脱位(2.1%),螺钉断裂(1.0%),和界面松动(1.0%)。此外,所有患者根据术前计划实现了定制假体的精确植入。T-SMART显示所有患者在假体-骨界面处具有出色的整合。
结论:使用3D打印的定制半骨盆内假体,以解剖学设计的轮廓和多孔仿生表面结构为特征,在原发性骨盆肿瘤治疗中,为内部半骨盆切除术后的骨盆带重建提供了潜在的选择。初步结果表明固定稳定,中期功能和影像学结果令人满意。
OBJECTIVE: Resection of pelvic bone tumours and subsequent pelvic girdle reconstruction pose formidable challenges due to the intricate anatomy, weight-bearing demands, and significant defects. 3D-printed implants have improved pelvic girdle reconstruction by enabling precise resections with customized guides, offering tailored solutions for diverse bone defect morphology, and integrating porous surface structures to promote osseointegration. Our study aims to evaluate the long-term efficacy and feasibility of 3D-printed hemipelvic reconstruction following resection of malignant pelvic tumours.
METHODS: A retrospective review was conducted on 96 patients with primary pelvic malignancies who underwent pelvic girdle reconstruction using 3D-printed custom hemipelvic endoprostheses between January 2017 and May 2022. Follow-up duration was median 48.1 ± 17.9 months (range, 6 to 76 months). Demographic data, imaging examinations, surgical outcomes, and oncological evaluations were extracted and analyzed. The primary endpoints included oncological outcomes and functional status assessed by the Musculoskeletal Tumor Society (MSTS-93) score. Secondary endpoints comprised surgical duration, intraoperative bleeding, pain control and complications.
RESULTS: In 96 patients, 70 patients (72.9%) remained disease-free, 15 (15.6%) had local recurrence, and 11 (11.4%) succumbed to metastatic disease. Postoperatively, function improved with MSTS-93 score increasing from 12.2 ± 2.0 to 23.8 ± 3.8. The mean operating time was 275.1 ± 94.0 min, and the mean intraoperative blood loss was 1896.9 ± 801.1 ml. Pain was well-managed, resulting in substantial improvements in VAS score (5.3 ± 1.8 to 1.4 ± 1.1). Complications occurred in 13 patients (13.5%), including poor wound healing (6.3%), deep prosthesis infection (4.2%), hip dislocation (2.1%), screw fracture (1.0%), and interface loosening (1.0%). Additionally, all patients achieved precise implantation of customized prosthetics according to preoperative plans. T-SMART revealed excellent integration at the prosthesis-bone interface for all patients.
CONCLUSIONS: The use of a 3D-printed custom hemipelvic endoprosthesis, characterized by anatomically designed contours and a porous biomimetic surface structure, offers a potential option for pelvic girdle reconstruction following internal hemipelvectomy in primary pelvic tumor treatment. Initial results demonstrate stable fixation and satisfactory mid-term functional and radiographic outcomes.