3D打印个体化人工椎体重建胸腰椎骨巨细胞瘤整块切除后脊柱的稳定性

3D printed custom-made prosthesis for spinal stability reconstruction in the thoracolumbar spine following total en bloc resection of giant cell tumor

中文关键词:  骨巨细胞瘤  脊柱  3D打印  人工椎体  整块切除

英文关键词:Giant cell tumor  Spine  3D printing  Custom-made prosthesis  Total en bloc resection

中文摘要:

  【摘要】 目的：探讨3D打印个体化人工椎体在胸腰椎骨巨细胞瘤整块切除后脊柱稳定性重建中的作用。方法：2017年1月~2019年12月我科共收治10例经病理检查证实且行全脊椎整块切除并用3D打印个体化人工椎体进行脊柱稳定性重建的胸腰椎骨巨细胞瘤患者。其中男性1例，女性9例；年龄38.3±13.7岁。9例为我院初治病例，1例为外院治疗后复发病例。均有不同程度的顽固的局部疼痛，术前疼痛视觉模拟评分（visual analogue scale，VAS）为4.5±1.2分；2例有双下肢不完全性瘫痪伴受累节段以下平面感觉减退，余患者肌力、感觉均正常。脊髓功能Frankel分级D级2例，E级8例。肿瘤部位：胸椎6例，腰椎4例；单节段5例，双节段2例，三节段3例。根据WBB（Weinstein-Boriani-Biagini）分期，肿瘤累及A~D区和B~D区各5例。7例采用单一后路肿瘤脊椎整块切除，3例采用前后路联合的方式行肿瘤全脊椎整块切除；肿瘤切除后均采用3D打印个体化人工椎体和钉棒系统进行脊柱稳定性重建。观察患者的术中术后并发症、术后神经功能、肿瘤控制和3D打印人工椎体的状态。结果：手术时间4.5~12.0h（6.5±2.0h）；术中失血2300~11500ml（4600±2444ml）。所有患者术后疼痛均明显缓解，术后VAS评分为1.3±0.5分。术后6例出现脑脊液漏，3例出现胸腔积液，无切口感染和伤口裂开等并发症发生。随访时间为7~33个月（16.0±7.9个月）。2例术前脊髓功能Frankel分级D级在术后3个月均恢复至E级。所有患者均存活，无肿瘤局部复发及肺转移。未见3D打印个体化人工椎体下沉或移位，无内固定松动或断裂。结论：对于胸腰椎骨巨细胞瘤，3D打印个体化人工椎体能够有效重建全脊椎整块切除后脊柱的稳定性。

英文摘要:

  【Abstract】 Objectives: To evaluate 3D printed custom-made prosthesis for spinal stability reconstruction after total en bloc spondylectomy(TES) of giant cell tumor in the thoracolumbar spine. Methods: Ten patients with giant cell tumor of the thoracolumbar spine underwent TES via a posterior approach or a combined anterior and posterior approach in our department between Jan. 2017 and Dec. 2019. 3D printed custom-made prosthesis was used to reconstruct the anterior column of the spine. The clinical data including clinical characteristics, perioperative complications, neurological status, tumor local control and the status of the prosthesis were retrospectively analyzed. There were one male and nine females with average age of 38.3±13.7 years. Nine were primary cases and one was recurrent case. All the patients had intractable back pain. The mean preoperative visual analogue scale(VAS) was 4.5±1.2. Two patients had partial paralysis accompanied by hypoesthesia below the affected segment. All other patients had normal spinal cord function. By Frankel grade, there were two grade D patients and eight grade E patients. The anatomic distribution of lesions was as follows: six in thoracic spine and four in lumbar spine. Lesion involved single segment in five cases, double segments in two cases, and three segments in three cases. According to the WBB staging, both A-D and B-D were in five cases respectively. Seven patients underwent TES from posterior approach, and meanwhile a combined anterior and posterior approach was chosen for the other three patients. 3D printed custom-made prosthesis and spinal pedicle screw system were used to reconstruct the spinal stability. Results: The average operation time was 6.5±2.0 hours(ranged 4.5-12.0 hours), and the average blood loss was 4600±2444ml(ranged 2,300-11,500ml). The back pain was relieved in all the patients after operation. The mean postoperative VAS was 1.3±0.5. Cerebrospinal fluid leakage occurred in six cases and pleural effusion in three cases during the perioperation. There was no wound infection or wound healing problems occurred. The mean follow-up period was 16.0±7.9 months(ranged 7-33 months). Of neurological function according to Frankel grade, the two patients recovered to grade E from grade D preoperatively. All the patients were alive with no evidence of tumor recurrence or metastasis. All the 3D printed custom-made prostheses were in situ and no subsidence or migration was found. There was no internal fixation loosening and fracture. Conclusions: 3D printed custom-made prosthesis can be effective in managing anterior reconstruction after TES.