Application of three-dimensional printed customized prosthesis with preserved epiphysis and articular surface in the reconstruction of large bone defects in treatment of adolescent femoral malignant tumors_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

NIU Xiaoying , GAO Shilei , QU Guoxin , LI Zhehuang , LIANG Xiaoxiao , YAO Weitao ,  ZHANG Peng

Department of Orthopedics and Soft Tissue, the Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou Henan, 450003, P. R. China;

Corresponding?author：

ZHANG Peng, Email: zdzp@zzu.edu.cn

Keywords：

Bone tumor; three-dimensional printed prosthesis; bone reconstruction; adolescent

DOI：

10.7507/1002-1892.202206058

Video：

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Objective To investigate the clinical application and effectiveness of three-dimensional (3D) printed customized prosthesis with preserved epiphysis and articular surface in the reconstruction of large bone defects in treatment of adolescent femoral malignant tumors. Methods The clinical data of 10 adolescent patients with femoral primary malignant tumor who met the selection criteria and underwent limb salvage surgery with 3D printed customized prosthesis with preserved epiphysis and articular surface between January 2020 and October 2021 were retrospectively analyzed. There were 6 males and 4 females with an average age of 12.5 years ranging from 7 to 18 years. There were 8 cases of osteosarcoma and 2 cases of Ewing’s sarcoma. Enneking stage was Ⅱb. The length of the lesions ranged from 76 to 240 mm, with an average of 138.0 mm. The length of osteotomy (i. e. length of customized prosthesis) ranged from 130 to 275 mm, with an average of 198.5 mm; the distance between distal osteotomy end and epiphyseal line ranged from 0 to 15 mm, with an average of 8.8 mm; the bone defect after osteotomy accounted for 37.36% to 79.02% of the total length of the lesion bone, with a mean of 49.43%. The operation time, intraoperative blood loss, complications, tumor outcome (refered to RESIST1.1 solid tumor efficacy evaluation criteria), and limb length discrepancy were recorded. The Musculoskeletal Cancer Society (MSTS) 93 score was used to evaluate the function at 6 months after operation, and visual analogue scale (VAS) score was used to evaluate the pain before and after operation. Results The operation was successfully performed in all the 10 patients, and the postoperative pathological results were consistent with the preoperative pathological results. The operation time was 165-440 minutes, with an average of 263 minutes; and the intraoperative blood loss was 100-800 mL, with an average of 350 mL. All patients were followed up 7-26 months, with an average of 11.8 months. No tumor was found on the osteotomy surface; the customized prosthesis were firmly installed and closely matched with the retained articular surface. The tumor outcome of neoadjuvant chemotherapy was stable in 4 cases and partial remission in 6 cases. No local recurrence or distant metastasis was found in 9 cases after postoperative adjuvant chemotherapy; pulmonary metastasis was found in 1 case at 12 months after operation. Two patients had local incision fat liquefaction, superficial infection, and delayed healing at 14 days after operation; 1 patient had local bone absorption at the contact surface of the prosthesis, and the screw and prosthesis did not loosen at 7 months after operation; the other patients had good incision healing, with no infection, prosthesis loosening, fracture, or other complications. At 6 months after operation, the MSTS93 score was 19-28, with an average of 24.1; 8 cases were excellent and 2 cases were good. The VAS score was 0.9±1.0, which significantly improved when compared with before operation (5.9±1.0) (t=23.717, P<0.001). The height of the patients increased by 1-12 cm, with an average of 4.6 cm. At last follow-up, 4 patients had limb length discrepancy, with a length difference of 1 cm in 2 cases and 2 cm in 2 cases. Conclusion The application of 3D printed customized prosthesis in the resection and reconstruction of adolescents femoral primary malignant tumors can achieve the purpose of preserving epiphysis and articular surface, and obtain good effectiveness.

Citation： NIU Xiaoying, GAO Shilei, QU Guoxin, LI Zhehuang, LIANG Xiaoxiao, YAO Weitao, ZHANG Peng. Application of three-dimensional printed customized prosthesis with preserved epiphysis and articular surface in the reconstruction of large bone defects in treatment of adolescent femoral malignant tumors. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(11): 1374-1380. doi: 10.7507/1002-1892.202206058 Copy

1.	徐海榮, 牛曉輝, 李遠, 等. 北京積水潭醫院原發骨腫瘤9200例分析. 骨科臨床與研究雜志, 2016, 1(1): 51-54, 61.
2.	郭衛. 肢體惡性骨腫瘤保肢治療的方法及原則. 北京大學學報 (醫學版), 2012, 44(6): 824-827.
3.	郭征. 我國骨肉瘤治療的現狀與問題及發展方向. 中國骨與關節雜志, 2015, 4(5): 338-342.
4.	Nauth A, McKee MD, Einhorn TA, et al. Managing bone defects. J Orthop Trauma, 2011, 25(8): 462-466.
5.	Wang F, Zhu J, Peng X, et al. The application of 3D printed surgical guides in resection and reconstruction of malignant bone tumor. Oncol Lett, 2017, 14(4): 4581-4584.
6.	李卡, 李建民, 楊志平, 等. 3D打印假體結合保留骨骺技術治療兒童骨肉瘤1例報道. 中華骨與關節外科雜志, 2019, 12(5): 381-383.
7.	Rengier F, Mehndiratta A, von Tengg-Kobligk H, et al. 3D printing based on imaging data: review of medical applications. Int J Comput Assist Radiol Surg, 2010, 5(4): 335-341.
8.	李建民, 楊強, 楊志平, 等. 骨肉瘤髓腔內侵襲范圍MRI測量與確定合理截骨平面的相關研究. 中國矯形外科雜志, 2005, 13(23): 1792-1794.
9.	付軍, 郭征, 范宏斌, 等. 應用3D打印假體重建下肢腫瘤性長節段骨缺損. 中華骨科雜志, 2017, 37(7): 433-440.
10.	燕太強, 梁偉民, 郭衛. 骨肉瘤的診療和研究進展. 中華臨床醫師雜志 (電子版), 2012, 6(17): 4988-4990.
11.	Portugal Gomes AC, Marques Ribeiro Naccarato C, Marchiori E. Osteosarcoma: Lymphatic spread in the thorax. Arch Bronconeumol, 2016, 52(9): 486. doi: 10.1016/j.arbres.2015.10.015.
12.	Yu C, Wang W. Relationship between P15 gene mutation and formation and metastasis of malignant osteosarcoma. Med Sci Monit, 2016, 22: 656-661.
13.	Rosen G, Marcove RC, Caparros B, et al. Primary osteogenic sarcoma: the rationale for preoperative chemotherapy and delayed surgery. Cancer, 1979, 43(6): 2163-2177.
14.	Simon MA, Aschliman MA, Thomas N, et al. Limb-salvage treatment versus amputation for osteosarcoma of the distal end of the femur. 1986. J Bone Joint Surg (Am), 2005, 87(12): 2822. doi: 10.2106/JBJS.8712.cl.
15.	Mauffrey C, Barlow BT, Smith W. Management of segmental bone defects. J Am Acad Orthop Surg, 2015, 23(3): 143-153.
16.	Dominkus M, Krepler P, Schwameis E, et al. Growth prediction in extendable tumor prostheses in children. Clin Orthop Relat Res, 2001, (390): 212-220.
17.	Neel MD, Heck R, Britton L, et al. Use of a smooth press-fit stem preserves physeal growth after tumor resection. Clin Orthop Relat Res, 2004, (426): 125-128.
18.	Pan KL, Chan WH, Ong GB, et al. Limb salvage in osteosarcoma using autoclaved tumor-bearing bone. World J Surg Oncol, 2012, 10: 105. doi: 10.1186/1477-7819-10-105.
19.	Jeys LM, Kulkarni A, Grimer RJ, et al. Endoprosthetic reconstruction for the treatment of musculoskeletal tumors of the appendicular skeleton and pelvis. J Bone Joint Surg (Am), 2008, 90(6): 1265-1271.
20.	姚偉濤, 蔡啟卿. 骨骺牽開保骺術在兒童股骨骨肉瘤保肢術中的應用. 中國修復重建外科雜志, 2013, 27(4): 423-427.
21.	于秀淳, 劉曉平, 周銀, 等. 保留骨骺滅活再植術治療兒童股骨遠端骨肉瘤. 中國矯形外科雜志, 2007, 15(11): 811-813.
22.	王臻, 郭征, 劉繼中, 等. 保留骨骺的保肢手術臨床研究. 中華骨科雜志, 2006, 26(12): 813-818.
23.	Manfrini M, Gasbarrini A, Malaguti C, et al. Intraepiphyseal resection of the proximal tibia and its impact on lower limb growth. Clin Orthop Relat Res, 1999, (358): 111-119.
24.	張忠, 王臻, 郭征, 等. 骨骺與移植骨不同固定方法的生物力學特征. 中國臨床康復, 2005, 9(10): 83-85.
25.	王中漢, 王辰宇, 劉賀, 等. 3D打印鈦合金孔隙支架骨長入影響因素的分析. 中國組織工程研究, 2016, 20(52): 7821-7828.
26.	于秀淳, 胡永成. 保留骨骺保肢手術治療兒童及青少年肢體骨肉瘤的基本原則與臨床療效. 中華骨科雜志, 2020, 40(2): 119-128.
27.	閻洪亮, 董揚. 保留骨骺的保肢技術在治療青少年膝關節周圍骨肉瘤患者中的應用進展. 中國骨與關節雜志, 2016, 4(5): 408-410.
28.	于秀淳, 徐明, 宋若先, 等. 保留骨骺滅活再植術治療兒童股骨遠端骨肉瘤的遠期療效. 中國骨腫瘤骨病, 2010, 9(2): 122-126.

1. 徐海榮, 牛曉輝, 李遠, 等. 北京積水潭醫院原發骨腫瘤9200例分析. 骨科臨床與研究雜志, 2016, 1(1): 51-54, 61.
2. 郭衛. 肢體惡性骨腫瘤保肢治療的方法及原則. 北京大學學報 (醫學版), 2012, 44(6): 824-827.
3. 郭征. 我國骨肉瘤治療的現狀與問題及發展方向. 中國骨與關節雜志, 2015, 4(5): 338-342.
4. Nauth A, McKee MD, Einhorn TA, et al. Managing bone defects. J Orthop Trauma, 2011, 25(8): 462-466.
5. Wang F, Zhu J, Peng X, et al. The application of 3D printed surgical guides in resection and reconstruction of malignant bone tumor. Oncol Lett, 2017, 14(4): 4581-4584.
6. 李卡, 李建民, 楊志平, 等. 3D打印假體結合保留骨骺技術治療兒童骨肉瘤1例報道. 中華骨與關節外科雜志, 2019, 12(5): 381-383.
7. Rengier F, Mehndiratta A, von Tengg-Kobligk H, et al. 3D printing based on imaging data: review of medical applications. Int J Comput Assist Radiol Surg, 2010, 5(4): 335-341.
8. 李建民, 楊強, 楊志平, 等. 骨肉瘤髓腔內侵襲范圍MRI測量與確定合理截骨平面的相關研究. 中國矯形外科雜志, 2005, 13(23): 1792-1794.
9. 付軍, 郭征, 范宏斌, 等. 應用3D打印假體重建下肢腫瘤性長節段骨缺損. 中華骨科雜志, 2017, 37(7): 433-440.
10. 燕太強, 梁偉民, 郭衛. 骨肉瘤的診療和研究進展. 中華臨床醫師雜志 (電子版), 2012, 6(17): 4988-4990.
11. Portugal Gomes AC, Marques Ribeiro Naccarato C, Marchiori E. Osteosarcoma: Lymphatic spread in the thorax. Arch Bronconeumol, 2016, 52(9): 486. doi: 10.1016/j.arbres.2015.10.015.
12. Yu C, Wang W. Relationship between P15 gene mutation and formation and metastasis of malignant osteosarcoma. Med Sci Monit, 2016, 22: 656-661.
13. Rosen G, Marcove RC, Caparros B, et al. Primary osteogenic sarcoma: the rationale for preoperative chemotherapy and delayed surgery. Cancer, 1979, 43(6): 2163-2177.
14. Simon MA, Aschliman MA, Thomas N, et al. Limb-salvage treatment versus amputation for osteosarcoma of the distal end of the femur. 1986. J Bone Joint Surg (Am), 2005, 87(12): 2822. doi: 10.2106/JBJS.8712.cl.
15. Mauffrey C, Barlow BT, Smith W. Management of segmental bone defects. J Am Acad Orthop Surg, 2015, 23(3): 143-153.
16. Dominkus M, Krepler P, Schwameis E, et al. Growth prediction in extendable tumor prostheses in children. Clin Orthop Relat Res, 2001, (390): 212-220.
17. Neel MD, Heck R, Britton L, et al. Use of a smooth press-fit stem preserves physeal growth after tumor resection. Clin Orthop Relat Res, 2004, (426): 125-128.
18. Pan KL, Chan WH, Ong GB, et al. Limb salvage in osteosarcoma using autoclaved tumor-bearing bone. World J Surg Oncol, 2012, 10: 105. doi: 10.1186/1477-7819-10-105.
19. Jeys LM, Kulkarni A, Grimer RJ, et al. Endoprosthetic reconstruction for the treatment of musculoskeletal tumors of the appendicular skeleton and pelvis. J Bone Joint Surg (Am), 2008, 90(6): 1265-1271.
20. 姚偉濤, 蔡啟卿. 骨骺牽開保骺術在兒童股骨骨肉瘤保肢術中的應用. 中國修復重建外科雜志, 2013, 27(4): 423-427.
21. 于秀淳, 劉曉平, 周銀, 等. 保留骨骺滅活再植術治療兒童股骨遠端骨肉瘤. 中國矯形外科雜志, 2007, 15(11): 811-813.
22. 王臻, 郭征, 劉繼中, 等. 保留骨骺的保肢手術臨床研究. 中華骨科雜志, 2006, 26(12): 813-818.
23. Manfrini M, Gasbarrini A, Malaguti C, et al. Intraepiphyseal resection of the proximal tibia and its impact on lower limb growth. Clin Orthop Relat Res, 1999, (358): 111-119.
24. 張忠, 王臻, 郭征, 等. 骨骺與移植骨不同固定方法的生物力學特征. 中國臨床康復, 2005, 9(10): 83-85.
25. 王中漢, 王辰宇, 劉賀, 等. 3D打印鈦合金孔隙支架骨長入影響因素的分析. 中國組織工程研究, 2016, 20(52): 7821-7828.
26. 于秀淳, 胡永成. 保留骨骺保肢手術治療兒童及青少年肢體骨肉瘤的基本原則與臨床療效. 中華骨科雜志, 2020, 40(2): 119-128.
27. 閻洪亮, 董揚. 保留骨骺的保肢技術在治療青少年膝關節周圍骨肉瘤患者中的應用進展. 中國骨與關節雜志, 2016, 4(5): 408-410.
28. 于秀淳, 徐明, 宋若先, 等. 保留骨骺滅活再植術治療兒童股骨遠端骨肉瘤的遠期療效. 中國骨腫瘤骨病, 2010, 9(2): 122-126.

Chinese Journal of Reparative and Reconstructive Surgery

Application of three-dimensional printed customized prosthesis with preserved epiphysis and articular surface in the reconstruction of large bone defects in treatment of adolescent femoral malignant tumors

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