3D打印截骨导板在骶骨肿瘤精准切除中的应用

Application of 3D-printed osteotomy guide plates in precise resection of sacral tumors

摘要

目的 探讨3D打印截骨导板在中、低位骶骨肿瘤精准切除中的临床应用效果及手术要点。方法 回顾性分析2020年5月至2024年5月福州市第二总医院骨与软组织肿瘤科收治的中位及以下11例骶骨肿瘤患者资料；其中男10例，女1例；年龄33~77（55.7±15.0）岁；S2及以下5例，S3及以下6例。病理类型包括脊索瘤9例（1例术后复发）、普通型骨肉瘤1例、低级别软骨肉瘤1例。术前通过CT和MRI影像评估肿瘤范围并以腰椎棘突或者无需切除的骶椎棘突和骶髂关节周围髂骨为解剖标志设计3D打印截骨导板。术中导板引导截骨，采用撬拨分离技术实现肿瘤整块切除。收集手术时间、术中出血、并发症及预后数据。结果 患者手术时间为（6.1±2.1）h，术中出血（1 618.2±791.0）mL。输血红细胞悬液（4.2±2.9）U、血浆（272.7±246.3）mL，随访3~59（34.7±18.9）个月。1例骨肉瘤患者术后3个月复发转移并放弃治疗而死亡；其余患者至少随访11个月。并发症包括切口感染2例、深部感染1例。1例骨肉瘤患者术后出现肠梗阻及复发转移；余10例患者随访期间均存在不同程度大小便障碍，但随访期间无复发转移；其中1例有逆行性射精，1例出现尿路感染，但无肠瘘、尿瘘、淋巴漏等严重并发症。结论 3D打印截骨导板可辅助实现中位及以下骶骨肿瘤精准切除，中短期疗效令人满意，为骶骨肿瘤的精准治疗提供了一种可靠方法。

Abstract

Objective To investigate the clinical application and surgical techniques of 3D-printed osteotomy guide plates in the precise resection of mid and lower sacral tumors. Methods A retrospective analysis was conducted on 11 patients with mid and lower sacral tumors treated in Department of Bone and Soft Tissue Tumors, Fuzhou Second General Hospital from May 2020 to May 2024. The cohort included 10 males and 1 female, with an age of 33-77 (55.7±15.0) years. Tumors were located at or below S2 in 5 patients and at or below S3 in 6 patients. Pathological diagnoses included chordoma in 9 patients (one with postoperative recurrence), conventional osteosarcoma in 1 patient and low-grade chondrosarcoma in 1 patient. Preoperative CT and MRI were used to assess tumor extent, and 3D-printed osteotomy guide plates were designed using anatomical landmarks such as the spinous processes of the lumbar vertebrae or sacral vertebrae did not need to be resected and the ilium around sacroiliac joint. Intraoperative osteotomy was guided by the plates, and en bloc tumor resection was achieved using a levering and separating technique. Operative time, intraoperative blood loss, complications, and prognosis were collected. Results The operative time was (6.1±2.1) hours; the intraoperative blood loss was (1 618.2±791.0) mL. The transfusion volume was (4.2±2.9) units of red cell suspension and (272.7±246.3) mL of plasma. Follow-up duration ranged from 3 to 59 (34.7±18.9) months. One patient with osteosarcoma experienced recurrence and metastasis at 3 months postoperatively and subsequently abandoned treatment, and the remaining patients were followed up for at least 11 months. Complications included incisional infection in 2 patients and deep infection in 1 patient. The patient with osteosarcoma also experienced postoperative intestinal obstruction and recurrence/metastasis. Among the remaining 10 patients, all had varying degrees of urinary and bowel dysfunction but with no recurrence or metastastis. One patient experienced retrograde ejaculation. One had a urinary tract infection. There were no severe complications such as enterocutaneous fistula, urocutaneous fistula, or lymphatic leak. Conclusions The method of 3D-printed osteotomy guide plates can facilitate precise resection of mid and lower sacral tumors. The clinical efficacy was satisfactory in the short-and medium-term follow-up. This approach provides a reliable method for the precise treatment of sacral tumors.

关键词

骨肿瘤 / 脊索瘤 / 打印，三维 / 截骨导板

Key words

Bone neoplasms / Chordoma / Printing, three-dimensional / Osteotomy guide plates

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基金资助

福建省自然科学基金(2022J011320)

福州市卫生健康中青年科学研究项目(2021-S-wq15)

福建省创伤骨科急救与康复临床医学研究中心项目(2020Y2014)