Objective: ?To evaluate the effectiveness of three-dimensional (3D) printing navigation templates assisting reconstruction with personalized unrestricted total knee prosthesis to treat maliganant bone tumors around the knee.
Methods: ?Between March 2007 and September 2014, 43 patients with malignant tumor around the knee were divided into 2 groups: 3D printing navigation templates assisting reconstruction with personalized unrestricted total knee prosthesis were used in 21 cases (trial group), and conventional tumor resection and reconstruction with hinged total knee prosthesis were used in 22 cases (control group). There was no significant difference in age, gender, tumor location, pathological diagnosis, tumor stage, diameter of tumor, disease duration, and preoperative visual analogue scale (VAS) score between 2 groups (P>0.05), which were comparable. Intraoperative length of tumor resection and blood loss were recorded and compared, and the postoperative complications and tumor recurrence were observed. The Musculoskeletal Tumor Society (MSTS) score was used to evaluate knee joint function.
Results: ?The operations were completed successfully in the patients of 2 groups and postoperative pathological results were negative in tumor resection margin. All the patients were followed up 12-77 months (mean, 36.7 months). There was no significant difference in the length of tumor resection and blood loss between trial group and control group (t=1.01, P=0.32; t=-0.76, P=0.45). In trial group, the resection range and reconstruction results were consistent with preoperative computer simulation; postoperative complications happened in 2 cases (9.52%); 1 case of immunological rejection and 1 case of infection); 2 cases (9.52%) had recurrence of osteosarcoma and pulmonary metastasis at 1 year after operation. In the control group, complication occurred in 6 cases (27.27%; 2 cases of periprosthetic fractures, 2 cases of infection, 1 case of incision nonunion, and 1 case of common peroneal nerve injury); 4 cases (18.18%) had recurrence of osteosarcoma and metastasis at 1 year after operation. There was no significant difference in postoperative complication and recurrence rate between 2 groups (χ2=2.24, P=0.14; χ2=0.67, P=0.41). At last follow-up, distal femur score of tumor and proximal tibial score of tumor in trial group were significantly better than those in control group (t=4.89, P=0.00; t=3.94, P=0.00). The mean flexion and extension range of motion of the knee joint was (115.45±12.25)° in trial group and was (101.49±11.96)° in control group, showing significant difference (t=3.78, P=0.00).
Conclusions: ?The effectiveness using 3D printing navigation templates assisting reconstruction with personalized unrestricted prosthesis for maliganant bone tumors around the knee is better than conventional tumor resection and reconstruction with hinged total knee prosthesis. It can improve the joint function better and the patients' quality of life.
目的: 评价 3D 打印导航模板辅助个性化非限制性肿瘤型全膝关节假体重建术治疗膝关节周围恶性骨肿瘤的疗效。.
方法: 2007 年 3 月-2014 年 9 月，共 43 例膝关节周围恶性骨肿瘤患者符合选择标准纳入研究。22 例采用传统肿瘤切除联合定制肿瘤型铰链式假体重建（对照组）， 21 例采用 3D 打印导航模板辅助个性化非限制性肿瘤型假体重建（试验组）。两组患者年龄、性别、肿瘤部位、病理诊断、肿瘤分期、肿瘤直径、病程以及术前疼痛视觉模拟评分（VAS）等一般资料比较，差异均无统计学意义（P>0.05），具有可比性。记录并比较两组术中切除瘤段长度及出血量，观察术后并发症及肿瘤复发情况；采用骨与软组织肿瘤协会（MSTS）保肢功能评分系统评价膝关节功能。.
结果: 两组患者均顺利完成手术，术后病理切片示切除边界均为阴性。两组患者均随访，随访时间12 ～ 77 个月，平均 36.7 个月。试验组术中切除瘤段长度及出血量与对照组比较，差异均无统计学意义（t=1.01，P=0.32； t=-0.76，P=0.45）。试验组：术后 X线片复查示手术切除范围和重建效果与术前计算机模拟切除重建一致；2 例（9.52%）发生并发症，其中免疫排斥反应 1 例、感染 1 例；术后 1 年 2 例（9.52%）骨肉瘤复发肺转移。对照组：术后 6 例（27.27%）发生并发症，其中假体周围骨折 2 例、感染 2 例、切口不愈合 1 例、腓总神经损伤 1 例；术后 1 年4 例（18.18%）骨肉瘤复发肺转移。两组术后并发症发生率及术后 1 年复发率比较，差异均无统计学意义（χ2=2.24，P=0.14； χ2=0.67， P=0.41）。末次随访时 MSTS 功能评分，试验组股骨远端、胫骨近端肿瘤评分均优于对照组股骨远端、胫骨近端肿瘤患者，比较差异有统计学意义（t=4.89，P=0.00； t=3.94，P=0.00）。试验组膝关节主动屈伸活动度为（115.45±12.25）°，对照组为（101.49±11.96）°，比较差异有统计学意义（t=3.78，P=0.00）。.
结论: 与采用传统肿瘤切除联合定制肿瘤型铰链式假体重建相比，采用 3D 打印导航模板辅助个性化非限制性肿瘤型假体重建治疗膝关节周围恶性骨肿瘤临床疗效良好，能更好地改善患者关节功能，提高患者生活质量。.
Keywords: Computer aided design; Joint reconstruction; Knee joint; Malignant bone tumor; Personalized unrestricted prosthesis.