Effect of three-dimensional printing navigation templates assisting reconstruction with personalized unrestricted total knee prosthesis for treating maliganant bone tumors around knees_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HUANGMinqiang ^1,2 ,  DINGHuanwen ¹ , CHENZhiyuan ³ , TENGQiang ^1,2 , WANGHong ¹

1. Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Area, Guangzhou Guangdong, 510010, P. R. China;
2. Graduate School, Traditional Chinese Medicine University of Guangzhou;
3. Department of Orthopedics, Affiliated Huangpu Hospital of Jinan University Medical School;

Corresponding author：

DINGHuanwen, Email: dhuanwen123@aliyun.com

Keywords：

Knee joint; Malignant bone tumor; Personalized unrestricted prosthesis; Computer aided design; Joint reconstruction

DOI：

10.7507/1002-1892.20160167

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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). Conclusion 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.

Citation： HUANGMinqiang, DINGHuanwen, CHENZhiyuan, TENGQiang, WANGHong. Effect of three-dimensional printing navigation templates assisting reconstruction with personalized unrestricted total knee prosthesis for treating maliganant bone tumors around knees. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(7): 815-821. doi: 10.7507/1002-1892.20160167 Copy

1.	潘伟, 郝永强, 严孟宁, 等.个体化数字导板结合3D打印技术在旋转铰链型人工膝关节置换术中的应用.国际骨科学杂志, 2015, 36(3): 231-234.
2.	Xu S, Yu X, Xu M, et al. Limb function and quality of life after various reconstruction methods according to tumor location following resection of osteosarcoma in distal femur. BMC Musculoskelet Disord, 2014, 15: 453.
3.	王晋, 尹军强, 邹昌业, 等.股骨上段恶性骨肿瘤的手术治疗.中国修复重建外科杂志, 2010, 24(7): 881-884.
4.	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. Clin Orthop Relat Res, 1993, (286): 241-246.
5.	Maki RG, Moraco N, Antonescu CR, et al. Toward better soft tissue sarcoma staging: building on american joint committee on cancer staging systems versions 6 and 7. Ann Surg Oncol, 2013, 20(11): 3377-3383.
6.	李栋, 马焕芝, 张伟, 等.肿瘤型铰链式人工膝关节置换术后假体相关并发症分析.中国修复重建外科杂志, 2015, 29(8): 936-940.
7.	Pala E, Trovarelli G, Calabrò T, et al. Survival of modern knee tumor megaprostheses: failures, functional results, and a comparative statistical analysis. Clin Orthop Relat Res, 2015, 473(3): 891-899.
8.	曹子龙.同种异体骨单髁置换治疗膝关节周围骨肿瘤的长期评价.济南:山东大学, 2015.
9.	杨应乾, 向阳, 胡军.定制肿瘤型旋转铰链式膝关节假体术后并发症发生相关因素的探讨.中国实用医药, 2015, 10(7): 74-76.
10.	覃澍, 董扬.肿瘤型膝关节假体术后并发症214例分析.中国骨与关节杂志, 2016, 5(2): 109-113.
11.	耿磊, 张浩强, 王臻, 等.膝关节周围骨巨细胞瘤人工关节置换术后疗效评价.中国骨与关节杂志, 2016, 5(1): 14-18.
12.	Bernthal NM, Greenberg M, Heberer K, et al. What are the functional outcomes of endoprosthestic reconstructions after tumor resection? Clin Orthop Relat Res, 2015, 473(3): 812-819.
13.	Nakamura T, Matsumine A, Uchida A, et al. Clinical outcomes of Kyocera Modular Limb Salvage system after resectionof bone sarcoma of the distal part of the femur the Japanese Musculoskeletal Oncology Group study. Int Orthop, 2014, 38(4): 825-830.
14.	沈余明, 马春旭, 胡骁骅, 等.膝关节周围严重皮肤软组织缺损的组织瓣修复策略.中华烧伤杂志, 2015, 31(5): 331-336.
15.	Zhang P, Feng F, Cai Q, et al. Effects of metaphyseal bone tumor removal with preservation of the epiphysis and knee arthroplasty. Exp Ther Med, 2014, 8(2): 567-572.
16.	荆琳, 张洪美, 韩露, 等.全膝关节置换术治疗膝关节恶性骨肿瘤.中华骨与关节外科杂志, 2015, 8(5): 424-428.
17.	丁焕文, 沈健坚, 涂强, 等.计算机辅助下膝关节周围肿瘤的精确切除与重建.中国骨与关节杂志, 2012, 1(1): 60-67.
18.	刘宏伟, 翁益平, 张云坤, 等.计算机辅助设计及电子束熔融快速成型金属3D打印技术制备个性化股骨假体.中国修复重建外科杂志, 2015, 29(9): 1088-1091.
19.	姚子龙.股骨远端肿瘤手术重建方式的生物力学研究.广州:南方医科大学, 2015.
20.	Fischer S, Soimaru S, Hirsch T, et al. Local tendon transfer for knee extensor mechanism reconstruction after soft tissue sarcoma resection. J Plast Reconstr Aesthet Surg, 2015, 68(5): 729-735.

1. 潘伟, 郝永强, 严孟宁, 等.个体化数字导板结合3D打印技术在旋转铰链型人工膝关节置换术中的应用.国际骨科学杂志, 2015, 36(3): 231-234.
2. Xu S, Yu X, Xu M, et al. Limb function and quality of life after various reconstruction methods according to tumor location following resection of osteosarcoma in distal femur. BMC Musculoskelet Disord, 2014, 15: 453.
3. 王晋, 尹军强, 邹昌业, 等.股骨上段恶性骨肿瘤的手术治疗.中国修复重建外科杂志, 2010, 24(7): 881-884.
4. 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. Clin Orthop Relat Res, 1993, (286): 241-246.
5. Maki RG, Moraco N, Antonescu CR, et al. Toward better soft tissue sarcoma staging: building on american joint committee on cancer staging systems versions 6 and 7. Ann Surg Oncol, 2013, 20(11): 3377-3383.
6. 李栋, 马焕芝, 张伟, 等.肿瘤型铰链式人工膝关节置换术后假体相关并发症分析.中国修复重建外科杂志, 2015, 29(8): 936-940.
7. Pala E, Trovarelli G, Calabrò T, et al. Survival of modern knee tumor megaprostheses: failures, functional results, and a comparative statistical analysis. Clin Orthop Relat Res, 2015, 473(3): 891-899.
8. 曹子龙.同种异体骨单髁置换治疗膝关节周围骨肿瘤的长期评价.济南:山东大学, 2015.
9. 杨应乾, 向阳, 胡军.定制肿瘤型旋转铰链式膝关节假体术后并发症发生相关因素的探讨.中国实用医药, 2015, 10(7): 74-76.
10. 覃澍, 董扬.肿瘤型膝关节假体术后并发症214例分析.中国骨与关节杂志, 2016, 5(2): 109-113.
11. 耿磊, 张浩强, 王臻, 等.膝关节周围骨巨细胞瘤人工关节置换术后疗效评价.中国骨与关节杂志, 2016, 5(1): 14-18.
12. Bernthal NM, Greenberg M, Heberer K, et al. What are the functional outcomes of endoprosthestic reconstructions after tumor resection? Clin Orthop Relat Res, 2015, 473(3): 812-819.
13. Nakamura T, Matsumine A, Uchida A, et al. Clinical outcomes of Kyocera Modular Limb Salvage system after resectionof bone sarcoma of the distal part of the femur the Japanese Musculoskeletal Oncology Group study. Int Orthop, 2014, 38(4): 825-830.
14. 沈余明, 马春旭, 胡骁骅, 等.膝关节周围严重皮肤软组织缺损的组织瓣修复策略.中华烧伤杂志, 2015, 31(5): 331-336.
15. Zhang P, Feng F, Cai Q, et al. Effects of metaphyseal bone tumor removal with preservation of the epiphysis and knee arthroplasty. Exp Ther Med, 2014, 8(2): 567-572.
16. 荆琳, 张洪美, 韩露, 等.全膝关节置换术治疗膝关节恶性骨肿瘤.中华骨与关节外科杂志, 2015, 8(5): 424-428.
17. 丁焕文, 沈健坚, 涂强, 等.计算机辅助下膝关节周围肿瘤的精确切除与重建.中国骨与关节杂志, 2012, 1(1): 60-67.
18. 刘宏伟, 翁益平, 张云坤, 等.计算机辅助设计及电子束熔融快速成型金属3D打印技术制备个性化股骨假体.中国修复重建外科杂志, 2015, 29(9): 1088-1091.
19. 姚子龙.股骨远端肿瘤手术重建方式的生物力学研究.广州:南方医科大学, 2015.
20. Fischer S, Soimaru S, Hirsch T, et al. Local tendon transfer for knee extensor mechanism reconstruction after soft tissue sarcoma resection. J Plast Reconstr Aesthet Surg, 2015, 68(5): 729-735.

Chinese Journal of Reparative and Reconstructive Surgery

Effect of three-dimensional printing navigation templates assisting reconstruction with personalized unrestricted total knee prosthesis for treating maliganant bone tumors around knees

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