目的:探讨3D 打印髋臼导板在骨盆原发恶性肿瘤患者半骨盆切除后骨盆修复重建中的应用价值及效果。方法回顾性分析2014年9月至2016年7月,在我科治疗的8例骨盆原发恶性肿瘤患者,男5例,女3例,年龄32~59岁,平均43.5岁,右侧5例,左侧3例,软骨肉瘤3例,骨肉瘤2例,尤文肉瘤1例,多形性肉瘤1例,恶性纤维组织细胞瘤1例,根据 Enneking 骨盆病变类型分为:I+II 区3例、II+III 区3例、I+II+III 区1例、I+II+IV 区1例,术前根据患者骨盆薄层 CT 三维重建患者骨盆结构,模拟手术并设计导板,术中行导板辅助下半骨盆切除、钉棒重建骨盆环、全髋关节置换术。结果8例均成功进行术前设计、导板制作并应用于术中定位。1例导板在消毒后出现轻微变形,经术中参考透视影像微调后放置满意,余7例均成功放置臼杯。手术时间5~8.2 h,平均6.4 h,术中出血3500~9000 ml,平均6200 ml。术后根据 X 线及 CT 评价示:患侧和健侧对比差异无统计学意义。1例术后出现切口内积液,经对症支持治疗后痊愈;1例术后5天因翻身不当出现髋关节脱位,行切开复位后未发生髋关节再脱位。8例均随访,随访2个月~2年,平均10个月,随访期间1例骨肉瘤患者于术后6个月出现肺转移,目前带瘤存活。其余患者术后恢复良好,随访期间未发现复发及转移。末次随访时 MSTS 评分为15~24分,平均20分。结论3D 打印髋臼导板能够辅助术中正确安装髋臼网杯位置,并减少手术时间、术中出血量及透视次数,术后评估显示髋臼位置良好,具有一定的创新性及不错的效果。
Objective To evaluate the value and effect of application of 3D printing acetabulum guide plate for confirming center of rotation and reconstruction of semi-pelvic in the patients with primary malignancy in pelvis. Methods Between September 2014 and July 2016, 8 patients with primary malignancy in pelvis were treated. There were 5 males and 3 females with an average age of 43.5 years ( range: 32 - 59 years ). In 5 cases the tumor was in right side and in 3 cases in left side. The 3 of the cases had chondrosarcoma, 2 cases had osteosarcoma, l case had Ewing sarcoma, 1 case had pleomorphic sarcoma and l case had malignant fibrous histiocytoma. According to the Enneking system for staging musculoskeletal tumors, the lesion involved ilium ( region I ) and acetabulum ( region II ) in 3 cases, acetabulum ( region II ) and ischium ( region III ) in 3 cases, ilium ( region I ), acetabulum ( region II ) and ischium ( region III ) in 1 case, acetabulum ( region II ), ischium ( region III ) and sacrum ( region IV ) in 1 case. For all the patients reconstruction of pelvic structure and surgical simulation were performed and guide plate was designed before surgery and application of 3D printing acetabulum guide plate for hemipelvectomy, reconstruction of pelvic ring and total hip arthroplasty. Results All the patients were succeeded with preoperative design, production and application of guide plate. Slight deformation of guide plate occurred in 1 case, and was adjusted for correct position in surgery; in the others acetabular cup was in correct position. The average surgical time was 6.4 hours ( range: 5 -8.2 hours ). The average blood loss was 6200 ml ( range: 3500 - 9000 m1 ). The data comparison of postoperative lesion side and normal side had no statistical significance based on the postoperative X ray and CT. Effusion in the wound occurred in 1 case, and was cured with symptomatic and supportive treatment; dislocation of hip joint occurred in 1 case because of improper turning over on the 5th day after the operation. All the patients were followed up, and the average follow-up time was 10 months ( range: 2 - 24 months ). During the follow-up, lung metastasis occurred in 1 case with osteosarcoma after 6 months, and was alive; the other patients had no local recurrence and metastasis. At the last follow-up, the average musculoskeletal tumor score ( MSTS ) was 20 ( range: 15 - 24 ). Conclusions The application of 3D printing acetabulum guide plate which could assist the installation of acetabular cup in the right location, reduce the operation time, blood loss and number of X-ray fluoroscopy, postoperative evaluation shows accurate acetabulum position. This technique has certain innovation and functional effectiveness.