3D打印全骶骨假体在全骶骨切除患者腰-髂稳定性重建中的应用

Reconstruction of the spinopelvic stability after total en bloc sacrectomy using a 3D-printed sacral endoprosthesis

中文关键词:  全骶骨切除  3D打印  假体  腰-髂稳定性重建

英文关键词:Total en bloc sacrectomy  3D printing  Endoprosthesis  Reconstruction of spinopelvic stability

中文摘要:

  【摘要】 目的：评估3D打印全骶骨假体在全骶骨切除患者腰-髂稳定性重建中的应用价值。方法：回顾性分析2015年1月～2018年12月于我中心接受全骶骨切除术的42例患者资料。根据重建方式将患者分为3组：假体重建组（14例）采用3D打印全骶骨假体重建，联合重建组（19例）采用包含前方椎体重建的联合重建方案，脊柱骨盆（SPF）重建组（9例）采用单纯SPF重建。比较三组患者的腰-髂稳定性（疼痛及运动功能评分）、内置物生存情况（内置物失败率及生存期）、手术安全性（手术时间、术中出血量及围手术期并发症发生率）。结果：术后平均随访时间为33.6±14.2个月。假体重建组手术平均耗时394.6±128.0min，术中出血量平均为3250.0±1711.4ml，共2例患者发生围手术期并发症。末次随访时，13例患者无需拐杖等辅助行走，12例患者无需使用止痛药。共4例患者发生影像学内置物失败，其中2例需行二次手术，1例因严重疼痛并伴有肿瘤复发接受二次手术，术中因假体与周围骨融合牢固而未取出假体；1例因严重疼痛及运动功能明显受损接受二次手术取出假体。假体重建组平均内置物生存期为49.3（95% CI 40.8～57.9）个月。相较于其他两组患者，假体重建组患者的腰-髂稳定性、内置物生存情况均与联合重建组相近（疼痛评分2.4±0.8 vs 2.3±0.7，P=0.59；运动功能评分2.4±0.6 vs 2.2±0.7，P=0.44；内置物失败率14.3% vs 5.3%，P=0.56；内置物生存期49.3 vs 59.4个月，P=0.28），并显著优于SPF重建组（疼痛评分2.4±0.8 vs 1.7±1.0，P=0.028；运动功能评分2.4±0.6 vs 1.3±0.7，P=0.001；内置物失败率14.3% vs 66.7%，P=0.023；内置物生存期49.3 vs 28.6个月，P=0.01），且不显著增加手术时间、术中出血及围手术期并发症发生率。结论：在全骶骨切除患者中应用3D打印全骶骨假体进行重建能够取得理想的腰-髂稳定性以及满意的内置物生存情况，同时不会增加手术风险。

英文摘要:

  【Abstract】 Objectives: To assess the value of 3D-printed sacral endoprosthesis in reconstruction of spinopel-vic stability after total en bloc sacrectomy(TES). Methods: 42 patients who underwent TES in our hospital between January 2015 and December 2018 were retrospectively reviewed. The patients were divided into three groups according to reconstructive option: an endoprosthesis group(14 patients), a combined reconstruction group(19 patients) treated with non-endoprosthetic combined reconstruction including anterior spinal column fixation, and a spinopelvic fixation(SPF) only group(9 patients). Spinopelvic stability(pain and motor function score), implant survival(IS)(failure rate and survival) and surgical safety(operative time, blood loss and perioperative complication rate) in the endoprosthesis group were assessed and compared with those of the other two groups. Results: The mean overall follow-up period was 33.6±14.2 months. In the endoprosthesis group, the mean surgical time and intraoperative hemorrhage was 394.6±128.0min and 3250.0±1711.4ml, respectively. Perioperative complications occurred in two patients. During the final follow-up, 13 patients could walk without aids and 12 patients without using analgesics. Imaging evidence of implant failure was found in 4 patients, including 2 patients who required reoperation. One of these, who had a local recurrence, underwent reoperation without removing the prosthesis due to the solid bone-endoprosthetic osseointegration. And the endoprosthesis of the other patient was removed in reoperation. The mean IS was 49.3(95% confidence interval 40.8-57.9) months. Compared with the other two groups, the endoprosthesis group showed satisfactory spinopelvic stability and IS, which were similar to those of combined reconstruction group(pain score, 2.4±0.8 vs 2.3±0.7, P=0.59; motor function score, 2.4±0.6 vs 2.2±0.7, P=0.44; implant failure rate, 14.3% vs 5.3%, P=0.56; IS, 49.3 vs 59.4 months, P=0.28) and significantly better than those of SPF group(pain score, 2.4±0.8 vs 1.7±1.0, P=0.028; motor function score, 2.4±0.6 vs 1.3±0.7, P=0.001; implant failure rate, 14.3% vs 66.7%, P=0.023; IS, 49.3 vs 28.6 months, P=0.01), with no significantly prolonged operative time, no greater intraoperative haemorrhage or higher perioperative complication rate. Conclusions: The use of 3D-printed endoprosthesis for reconstruction after TES provides reliable spinopelvic stability and IS without endangering the surgical safety.