3D-printed prostheses for large bone defect reconstruction following bone tumor surgery北大核心

BACKGROUND: Tumor segment resection is one of the standard methods for the treatment of bone tumors. However, the reconstruction of bone defects atumor resection faces many challenges. A growing number of researchers are focusing on 3D-printed prostheses for bone defect repair and reconstruction following bone tumor surgery. OBJECTIVE: To explore the feasibility of 3D-printed prostheses in the reconstruction of large bone defect following bone tumor surgery and to evaluate the postoperative outcomes. METHODS: Retrospective analysis of clinical data of 24 patients [19 males and 5 females, age 23.8 (6-61) years] who underwent bone tumor resection and 3D-printed prosthesis implantation in the Department of Bone Oncology, the First Affiliated Hospital of Xinjiang Medical University from December 2020 to September 2021 was conducted. There were 7 cases with distal femur tumor, 5 with pelvis tumor, 4 with proximal tibia tumor, 3 with middle femur tumor, 1 with distal tibia tumor, 1 with proximal humerus tumor, 1 with middle humerus tumor, 1 with scapula tumor, 1 with ulna tumor, and 22 cases with primary tumors (13 osteosarcoma, 4 Ewing sarcoma, 2 giant cell tumor of bone, 1 chondroblastoma, 1 chondrosarcoma, and 1 osteoblastoma), 2 metastatic carcinoma. Preoperative and postoperative imaging data were recorded and neoadjuvant chemotherapy was administered in 17 cases before surgery. The Musculoskeletal Tumour Society score was used to assess limb function before surgery and 6 months after surgery, and pain was assessed by the Visual Analog Scale, as well as the complications were recorded. RESULTS AND CONCLUSION: (1) All patients undergoing resection of the tumor segment and 3D-printed prosthesis implantation for the reconstruction of the bone defect were followed for 6-49 months, and the results showed that the length of osteotomy was (18.2 ± 7.3) cm and an average intraoperative bleeding volume was 740 (100-3 000) mL. (2) Two patients died of systemic metastasis, the remaining 22 had no pulmonary metastasis or recurrence during the follow-up period, and 1 patient developed aseptic loosening of the prosthesis at 25 months postoperatively. (3) The Musculoskeletal Tumour Society scores were significantly increased, while Visual Analog Scale scores were significantly decreased (P < 0.05) at 6 months postoperatively. (4) The Musculoskeletal Tumor Society score was rated excellent in all 22 patients at the final follow-up. (5) These results suggest that 3D-printed prosthesis is suitable for the reconstruction of large bone defects caused by bone tumor resection. Patients have good postoperative function and few complications. However, further investigations are needed to explore long-term follow-up results. © 2023, Publishing House of Chinese Journal of Tissue Engineering Research. All rights reserved.     

微型钢板内固定治疗多发性掌骨骨折7例疗效分析

手部掌骨骨折的类型多种多样，治疗方法也不尽相同。随着交通事故的增多及生产机械化程度的提高，手部掌骨骨折的程度也愈来愈重，多数表现为多发性、粉碎性或开放性骨折，同时伴有较大面积的骨及软组织缺损。治疗这类骨折的一般原则是：对于闭和性骨折，若移位不明显，可以采用石膏等外固定的方法；对于多发性、粉碎性、关节面附近的骨折和开放性骨折，则应采用手术治疗。如何选用合适的固定材料进行固定是临床医生所面临的一个重要问题，我院2003年5月～2004年8月采用微型钢板内固定治疗7例多发性掌骨骨折患者，取得了满意的疗效，现报道如下。     

NLR、LMR和PLR与骨肉瘤预后的关系

目的 探讨术前中性粒细胞/淋巴细胞比值（NLR）、淋巴细胞/单核细胞比值（LMR）、血小板/淋巴细胞比值（PLR）对预测骨肉瘤患者预后的影响。方法 回顾性分析接受同样治疗方案的70例骨肉瘤患者的临床和生存资料,计算出初次确诊为骨肉瘤时的NLR、PLR和LMR,ROC曲线分析NLR、PLR和LMR的AUC值并确定最佳预测诊断截断值后分高低两组,Kaplan-Meier法绘制生存曲线,Cox比例风险回归模型分析预后因素。结果 以NLR=3.025、LMR=4.82和PLR=111.5为界,高NLR组患者的3、5年生存率分别为42.0%、28.0%,低NLR组分别为73.9%、60.2%（P=0.002）,高LMR组分别为71.1%、55.3%（P<0.001）,低LMR组分别为33.3%、10.4% ,高PLR组分别为30.8%、23.8%,低PLR组分别为63.6%、56.6%（P=0.001）。单因素分析显示NLR、PLR及LMR水平、肺转移均与患者死亡明显相关（P<0.05）,多因素Cox回归分析显示NLR及LMR水平是影响患者总生存率的独立预后因素。结论 NLR、LMR水平是预测骨肉瘤患者预后的指标之一,NLR>3.025、LMR<4.82者生存期较短,可能需更积极化疗和密切随访改善临床治疗结果。     

单侧双通道内镜技术在腰椎布鲁菌病脊柱炎治疗中的应用研究

背景 单侧双通道内镜（UBE）技术是一种新兴的脊柱微创手术技术，近年来已被用于治疗各种退行性脊柱疾病。然而，尚未有相关文献报道该技术治疗腰椎布鲁菌病脊柱炎（LBS）。 目的 探讨UBE技术治疗LBS的有效性及可行性。 方法 选取2020年1月至2021年6月新疆医科大学第一附属医院骨科收治的LBS接受UBE技术治疗的患者13例。记录手术时间、可估计失血量及并发症发生情况。分析红细胞沉降率（ESR）、C反应蛋白（CRP）、腰背部和腿部视觉模拟评分（VAS）、日本骨科协会（JOA）评分、Oswestry残疾指数（ODI）、美国脊髓损伤协会（ASIA）神经系统分型和前凸角等临床结果。所有患者术后1年随访时采用改良Macnab标准进行评估。采用Bridwell分级标准评估椎间植骨融合情况。 结果 13例LBS患者手术时间145~210 min，平均（177.31±19.54）min；可估计失血量120~290 ml，平均（176.15±43.79）ml；共发生2例并发症，发生率为2/13。术后3个月随访，ESR和CRP水平恢复正常。术后各随访时间点腰背部和腿部VAS、JOA评分及ODI均较术前明显改善，差异有统计学意义（P<0.05）。术后1年随访时改良Macnab标准评价示：优10例、良2例、可1例、差0例，优良率为12/13。前凸角由术前（47.18°±6.88°）降至出院前（40.83°±6.71°），术后1年随访时无明显角度丢失。所有患者术后1年随访时获得骨性融合，其中12例融合等级为Ⅰ级、1例为Ⅱ级，融合率为12/13。 结论 UBE技术是治疗LBS的一种有效、安全、可行的手术方式。