With the developing of three-dimensional (3D) printing technology, it is widely used in the treatment of bone tumors in the clinical orthopedics. Because of the great individual differences in the location of bone tumor, resection and reconstruction are difficult. Based on 3D printing technology, the 3D models can be prepared to show the anatomical part of the disease, so that the surgeons can create a patient-specific operational plans based on better understand the local conditions. At the same time, preoperative simulation can also be carried out for complex operations and patient-specific prostheses can be further designed and prepared according to the location and size of tumor, which may have more advantages in adaptability. In this paper, the domestic and international research progress of 3D printing technology in the treatment of limb bone tumors in recent years were reviewed and summarized.
ObjectiveTo investigate the feasibility and effectiveness of proximal tibial hemiprosthesis replacement in the first stage and prosthesis revision in the second stage in reducing the risk of length discrepancy of limbs in children with proximal tibial osteosarcoma.MethodsBetween 2009 and 2013, 3 children with conventional osteosarcoma at the proximal tibia (stage ⅡB) were treated. There were 2 boys and 1 girl. They were 12, 13, and 13 years old, respectively. After 4 courses of preoperative chemotherapy, the proximal tumor segmental resection and proximal tibial hemiprosthesis replacement were performed. Then the patients underwent prosthetic revision in the second stage when they were 20, 17, and 17 years old, respectively.ResultsAll patients successfully completed two stages of operations. The length discrepancy of lower limb after the second stage operation were 19, 7, and 21 mm, respectively. Three patients were followed up 13, 3, and 27 months after the second stage operation, and the lower extremities functions were satisfactory. The Musculoskeletal Tumor Society (MSTS) score was 26, 27, and 25, respectively.ConclusionThe proximal tibial hemiprosthesis replacement in the first stage combined with prosthesis revision in the second stage for treating the proximal tibia osteosarcoma in children can keep the distal femur growth ability, reduce the length discreapancy of lower limb, and obtain satisfactory stability and good function.
ObjectiveTo report the preliminary clinical results and analyze the prognostic factors of prosthetic failures with non-cemented modular prosthetic reconstruction after tumor resection in lower extremities.MethodsA clinical data of 150 patients with lower extremity tumors treated with MEGASYSTEM-C non-cemented modular prosthetic reconstruction between October 2011 and September 2016 was retrospectively analyzed. There were 88 males and 62 females, aged from 12 to 81 years, with a median age of 24 years. According to World Health Organization (WHO) classification of bone tumors, 120 cases were primary malignant tumors, 27 cases were intermediate tumors, and 3 cases were metastatic tumors. Among them, 134 cases underwent primary operation and 16 cases underwent reoperation after recurrence. Eighty-seven patients with malignant tumors received chemotherapy before and after operation, and no patient received local radiotherapy during perioperative period. Proximal femur was reconstructed in 32 cases, distal femur in 83 cases, and proximal tibia in 35 cases. The postoperative follow-up time, the results of oncology (survival status and tumor recurrence), and prosthesis failure (prosthesis survival rate, reasons for failure, treatment plan after failure) were recorded. The reason of the prosthesis failure was classified into 5 types according to the classification defined by Henderson et al. Kaplan-Meier survival analysis and Log-Rank test were used to analyze patient and prosthesis survival. Lower extremity function was assessed by using the Musculoskeletal Tumor Society (MSTS) scoring system and MSTS scores were compared for patients with different reconstruction sites.ResultsAll patients were followed up 5-84 months, the median follow-up time was 39 months. During the follow-up period, there were 116 cases of tumor-free survival, 10 cases of tumor-bearing survival, and 24 died of lung metastasis or multiple metastases. The 3-year and 5-year survival rates of 120 patients with primary malignant tumors were 83.1% and 76.6%. There was no significant difference in survival rate between different reconstruction sites (P=0.851). Seven cases (4.7%) had local recurrence at 7-21 months after operation. The 3-year and 5-year survival rates of the prosthesis in 150 patients were 94.4% and 92.5%. There was no significant difference in survival rate between different reconstruction sites (P=0.765). There were 26 failures in 24 patients (16.0%) during the follow-up period. There were 9 cases of type 1 failure, 1 case of type 2 failure, 3 cases of type 3 failure, 5 cases of type 4 failure, and 8 cases of type 5 failure. At last follow-up, 120 of the 126 patients survived without prosthetic failure. Except that the influence of different parts of prosthesis on the incidence of type 4 failure (P=0.029), the influence of chemotherapy on the incidence of type 5 failure (P=0.002) were significant, the influence of other types of failure on different reconstructed parts of prosthesis, initial operation, and perioperative chemotherapy had no significant difference (P>0.05). There were 5 cases of amputation (4 cases of type 5 failure, 1 case of type 4 failure), 3 cases of prosthesis removal (1 case of type 2 failure, 1 case of type 3 failure, 1 case of type 4 failure), 3 cases of revision while keeping the original prosthesis (2 cases of type 1 failure, 1 case of type 5 failure). The overall MSTS score was 24±3. The MSTS scores were 24±3, 25±3, and 23±3 in patients whose reconstruction sites located in proximal femur, distal femur, and proximal tibia, respectively, showing no significant difference (F=3.014, P=0.052).ConclusionThe short-term follow-up showed a lower incidence of complications and good function for MEGASYSTEM-C non-cement modular prosthesis system in treatment of bone defects after lower limb tumor resection. The main factors affecting the early survival of prosthesis were tumor progression and infection.
Objective To investigate short-term effectiveness and clinical application advantages of orthopedic robot-assisted resection for osteoid osteoma compared with traditional open surgery. Methods A retrospective analysis was conducted on clinical data of 48 osteoid osteoma patients who met the selection criteria between July 2022 and April 2023. Among them, 23 patients underwent orthopedic robot-assisted resection (robot-assisted surgery group), and 25 patients received traditional open surgery (traditional surgery group). There was no significant difference (P>0.05) in gender, age, disease duration, lesion location and size, and preoperative visual analogue scale (VAS) score, and musculoskeletal tumor society (MSTS) score between the two groups. The surgical time, intraoperative blood loss, intraoperative lesion localization time, initial localization success rate, infection, and recurrence were recorded and compared. VAS scores before surgery and at 24 hours, 1, 3, 6, and 9 months after surgery and MSTS score before surgery and at 3 months after surgery were assessed. Results All patients completed the surgery successfully, with no significant difference in surgical time between the two groups (P>0.05). Compared to the traditional surgery group, the robot-assisted surgery group had less intraoperative blood loss, shorter lesion localization time, and shorter hospitalization time, with significant differences (P<0.05). The initial localization success rate was higher in the robot-assisted surgery group than in the traditional surgery group, but the difference between the two groups was not significant (P>0.05). All patients in both groups were followed up, with the follow-up time of 3-12 months in the robot-assisted surgery group (median, 6 months) and 3-14 months in the traditional surgery group (median, 6 months). The postoperative MSTS scores of both groups improved significantly when compared to those before surgery (P<0.05), but there was no significant difference in the changes in MSTS scores between the two groups (P>0.05). The postoperative VAS scores of both groups showed a gradually decreasing trend over time (P<0.05), but there was no significant difference between the two groups after surgery (P>0.05). During follow-up, except for 1 case of postoperative infection in the traditional surgery group, there was no infections or recurrences in other cases. There was no significant difference in the incidence of postoperative infection between the two groups (P>0.05). Conclusion Orthopedic robot-assisted osteoid osteoma resection achieves similar short-term effectiveness when compared to traditional open surgery, with shorter lesion localization time.