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目的：探讨应用3D打印定制肱骨远端半肘关节假体的围手术期安全性、肿瘤学预后、假体相关并发症、术后功能状态。方法：回顾性分析2018年6月至2019年6月收治的7例肱骨远端恶性肿瘤患者。7例患者均行瘤段截除、3D打印肱骨远端半肘关节置换术。总结7例患者的基线资料、手术相关资料、肿瘤学预后、假体相关并发症及术后功能状态。结果：假体的生产周期为7～12 d，平均（8.4±1.9）d，在假体准备过程中无一例出现肿瘤进展。手术时间为100～240 min，平均（137±51）min；术中失血量为50～750 ml，平均（207±254）ml。所有假体均在术中顺利植入，无一例发生术中并发症。随访12～24个月，平均随访（18.4±5.0）个月（12～24月），所有患者均存活。术后并发症包括1例桡神经麻痹和1例假体半脱位。末次随访时屈肘活动度为100°～135°，平均（119.3±11.7）°；伸肘受限度为0°～30°，平均（10.0±13.8）°。美国肌肉骨骼肿瘤学会-93量表（MSTS-93）评分为26～28分，平均（27.6±0.8）分；Mayo肘关节功能评分（MEPS）为95～100分，平均（98.6±2.4）分，提示功能状态优良。结论：对于肱骨远端肿瘤切除术后的骨缺损，应用3D打印定制肱骨远端半肘关节假体具有良好的安全性，并可获得满意的功能状态。
Abstract：Objective: To evaluate the perioperative safety, oncological and prosthetic outcomes, and postoperative functional status of a 3D-printed, distal humeral prosthesis with elbow hemiarthroplasty. Methods: From June 2018 to June 2019, seven patients with malignancies involving the distal humerus were treated by en bloc resection and reconstruction with a 3D-printed, hemiarthroplastic prosthesis in our center. We summarized the baseline and operative data, oncological outcome, complication profiles and functional status of these patients. Results: The mean time for production of the prosthesis was(8.4±1.9) d(range, 7-12 d). No tumor progression occurred during prosthesis preparation. The mean operation time was(137±51) min(range, 100-240 min). Intraoperative hemorrhage was(207 ± 254) ml on average(range, 50-750 ml). All prostheses were implanted successfully and no intraoperative complications happened. During a mean follow-up of(18.4±5.0) months(12-24 months), no patients died and complications occurred in two patients(1 temporary palsy of radial nerve and 1 subluxation). At the final follow-up, the mean flexion of the elbow was 119.3°±11.7°(100°-135°) and the mean extension was 10.0°±13.8°(0°-30°). The mean Musculoskeletal Tumor Society-93(MSTS-93) score and Mayo elbow performance score(MEPS) were 27.6±0.8(26-28) and 98.6±2.4(95-100), respectively, indicating excellent functional status.Conclusions: Application of the custom-made, 3D-printed distal humeral prosthesis with hemiarthroplasty is safe and can achieve satisfactory functional status after resection of a distal humeral tumor.
[1]Weber KL,Lin PP,Yasko AW.Complex segmental elbow reconstruction after tumor resection[J].Clin Orthop Relat Res,2003(415):31-44.
[2]Kulkarni A,Fiorenza F,Grimer RJ,et al.The results of endoprosthetic replacement for tumours of the distal humerus[J].J Bone Joint Surg Br,2003,85(2):240-243.
[3]Henrichs MP,Liem D,Gosheger G,et al.Megaprosthetic replacement of the distal humerus:still a challenge in limb salvage[J].J Shoulder Elbow Surg,2019,28(5):908-914.
[4]Casadei R,De Paolis M,Drago G,et al.Total elbow arthroplasty for primary and metastatic tumor[J].Orthop Traumatol Surg Res,2016,102(4):459-465.
[5]Capanna R,Muratori F,Campo FR,et al.Modular megaprosthesis reconstruction for oncological and non-oncological resection of the elbow joint[J].Injury,2016,47 Suppl 4:S78-S83.
[6]Athwal GS,Chin PY,Adams RA,et al.Coonrad-Morrey total elbow arthroplasty for tumours of the distal humerus and elbow[J].J Bone Joint Surg Br,2005,87(10):1369-1374.
[7]Hanna SA,David LA,Aston WJ,et al.Endoprosthetic replacement of the distal humerus following resection of bone tumours[J].J Bone Joint Surg Br,2007,89(11):1498-1503.
[8]Tang X,Guo W,Yang R,et al.Custom-made prosthesis replacement for reconstruction of elbow after tumor resection[J].J Shoulder Elbow Surg,2009,18(5):796-803.
[9]Liang H,Ji T,Zhang Y,et al.Reconstruction with 3D-printed pelvic endoprostheses after resection of a pelvic tumour[J].Bone Joint J,2017,99-B(2):267-275.
[10]Enneking WF,Dunham W,Gebhardt MC,et al.A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system[J].Clin Orthop Relat Res,1993(286):241-246.
[11]Cusick MC,Bonnaig NS,Azar FM,et al.Accuracy and reliability of the Mayo elbow performance score[J].J Hand Surg Am,2014,39(6):1146-1150.
[12]Funovics PT,Schuh R,Adams SB,et al.Modular prosthetic reconstruction of major bone defects of the distal end of the humerus[J].J Bone Joint Surg Am,2011,93(11):1064-1074.
[13]Gulia A,Pruthi M,Gupta S,et al.Elbow reconstruction after excision of proximal ulna tumors:challenges and solutions[J].J Clin Orthop Trauma,2021,20:101496.
[14]Sewell MD,Hanna SA,Pollock RC,et al.Proximal ulna endoprosthetic replacement for bone tumours in young patients[J].Int Orthop,2012,36(5):1039-1044.
[15]Sanchez-Sotelo J.Total elbow arthroplasty[J].Open Orthop J,2011,5:115-123.
[16]Foruria AM,Sanchez-Sotelo J,Oh LS,et al.The surgical treatment of periprosthetic elbow fractures around the ulnar stem following semiconstrained total elbow arthroplasty[J].J Bone Joint Surg Am,2011,93(15):1399-1407.
[17]Nestorson J,Ekholm C,Etzner M,et al.Hemiarthroplasty for irreparable distal humeral fractures:medium-term follow-up of 42 patients[J].Bone Joint J,2015,97-B(10):1377-1384.
[18]Alizadehkhaiyat O,Al Mandhari A,Sinopidis C,et al.Total elbow arthroplasty:a prospective clinical outcome study of Discovery Elbow System with a 4-year mean follow-up[J].J Shoulder Elbow Surg,2015,24(1):52-59.
[19]Attarilar S,Ebrahimi M,Djavanroodi F,et al.3D printing technologies in metallic implants:a thematic review on the techniques and procedures[J].Int J Bioprint,2021,7(1):306.
[20]Raheem AA,Hameed P,Whenish R,et al.A review on development of bio-inspired implants using 3D printing[J].Biomimetics (Basel),2021,6(4):65.
[21]Yeung CM,Lans J,Kuechle JB,et al.Evaluation of the proximal ulna dorsal angulation for ulnar component sizing in elbow prosthetic reconstruction after distal humeral resection of tumor[J].J Am Acad Orthop Surg Glob Res Rev,2020,4(5):e2000062.
[22]Dunn J,Kusnezov N,Pirela-Cruz M.Distal humeral hemiarthroplasty:indications,results,and complications.A systematic review[J].Hand (N Y),2014,9(4):406-412.
[23]Adolfsson L,Nestorson J.The Kudo humeral component as primary hemiarthroplasty in distal humeral fractures[J].JShoulder Elbow Surg,2012,21(4):451-455.
基本信息:
中图分类号:R687.3
引用信息:
[1]郭卫,梁海杰,杨毅,等.3D打印半肘关节假体重建肱骨远端骨缺损的早期临床疗效[J],2022,15(07):524-531.
基金信息:
北京大学人民医院研究与发展基金（2147000205）