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Hu X, Lu M, Wang Y, Luo Y, Zhou Y, Yang X, Min L, Tu C. 3D-Printed custom-made hemipelvic endoprosthetic reconstruction following periacetabular tumor resection: utilizing a novel classification system. BMC Musculoskelet Disord 2024; 25:384. [PMID: 38755628 PMCID: PMC11097426 DOI: 10.1186/s12891-024-07509-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 05/08/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Customized 3D-printed pelvic implants with a porous structure have revolutionized periacetabular pelvic defect reconstruction after tumor resection, offering improved osteointegration, long-term stability, and anatomical fit. However, the lack of an established classification system hampers implementation and progress. METHODS We formulated a novel classification system based on pelvic defect morphology and 3D-printed hemipelvis endoprostheses. It integrates surgical approach, osteotomy guide plate and prosthesis design, postoperative rehabilitation plans, and perioperative processes. RESULTS Retrospectively analyzing 60 patients (31 males, 29 females), we classified them into Type A (15 patients: Aa = 6, Ab = 9), Type B (27 patients: Ba = 15, Bb = 12), Type C (17 patients). All underwent customized osteotomy guide plate-assisted tumor resection and 3D-printed hemipelvic endoprosthesis reconstruction. Follow-up duration was median 36.5 ± 15.0 months (range, 6 to 74 months). The mean operating time was 430.0 ± 106.7 min, intraoperative blood loss 2018.3 ± 1305.6 ml, transfusion volume 2510.0 ± 1778.1 ml. Complications occurred in 13 patients (21.7%), including poor wound healing (10.0%), deep prosthesis infection (6.7%), hip dislocation (3.3%), screw fracture (1.7%), and interface loosening (1.7%). VAS score improved from 5.5 ± 1.4 to 1.7 ± 1.3, MSTS-93 score from 14.8 ± 2.5 to 23.0 ± 5.6. Implant osseointegration success rate was 98.5% (128/130), with one Type Ba patient experiencing distal prosthesis loosening. CONCLUSION The West China classification may supplement the Enneking and Dunham classification, enhancing interdisciplinary communication and surgical outcomes. However, further validation and wider adoption are required to confirm clinical effectiveness.
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Affiliation(s)
- Xin Hu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, Sichuan, 610041, China
| | - Minxun Lu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, Sichuan, 610041, China
| | - Yitian Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, Sichuan, 610041, China
| | - Yi Luo
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, Sichuan, 610041, China
| | - Yong Zhou
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, Sichuan, 610041, China
| | - Xiao Yang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, Sichuan, 610064, People's Republic of China.
- Provincial Engineering Research Center for Biomaterials Genome of Sichuan, Sichuan University, Chengdu, 610064, China.
| | - Li Min
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China.
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, Sichuan, 610041, China.
| | - Chongqi Tu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, Sichuan, 610041, China
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Hu X, Wen Y, Lu M, Luo Y, Zhou Y, Yang X, Tu C, Min L. Biomechanical and clinical outcomes of 3D-printed versus modular hemipelvic prostheses for limb-salvage reconstruction following periacetabular tumor resection: a mid-term retrospective cohort study. J Orthop Surg Res 2024; 19:258. [PMID: 38654343 DOI: 10.1186/s13018-024-04697-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/22/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Debates persist over optimal pelvic girdle reconstruction after acetabular tumor resection, with surgeons grappling between modular and 3D-printed hemipelvic endoprostheses. We hypothesize superior outcomes with 3D-printed versions, yet scarce comparative research exists. This study fills the gap, examining biomechanics and clinical results retrospectively. METHODS From February 2017 to June 2021, we retrospectively assessed 32 patients undergoing en bloc resection for malignant periacetabular tumors at a single institution. PRIMARY OUTCOME limb function. SECONDARY OUTCOMES implant precision, hip joint rotation center restoration, prosthesis-bone osteointegration, and complications. Biomechanical characteristics were evaluated through finite element analysis on pelvic defect models. RESULTS In the 3D-printed group, stress distribution mirrored a normal pelvis, contrasting the modular group with elevated overall stress, unstable transitions, and higher stress peaks. The 3D-printed group exhibited superior functional scores (MSTS: 24.3 ± 1.8 vs. 21.8 ± 2.0, p < 0.05; HHS: 79.8 ± 5.2 vs. 75.3 ± 3.5, p < 0.05). Prosthetic-bone interface osteointegration, measured by T-SMART, favored 3D-printed prostheses, but surgery time (426.2 ± 67.0 vs. 301.7 ± 48.6 min, p < 0.05) and blood loss (2121.1 ± 686.8 vs. 1600.0 ± 505.0 ml, p < 0.05) were higher. CONCLUSIONS The 3D-printed hemipelvic endoprosthesis offers precise pelvic ring defect matching, superior stress transmission, and function compared to modular endoprostheses. However, complexity, fabrication expertise, and challenging surgical implantation result in prolonged operation times and increased blood loss. A nuanced consideration of functional outcomes, complexity, and patient conditions is crucial for informed treatment decisions. LEVEL OF EVIDENCE Level III, therapeutic study (Retrospective comparative study).
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Affiliation(s)
- Xin Hu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xang, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yang Wen
- Department of Orthopedics, Zigong Fourth People's Hospital, Zigong, 643000, People's Republic of China
| | - Minxun Lu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xang, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yi Luo
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xang, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yong Zhou
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xang, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xiao Yang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, 610064, Sichuan, People's Republic of China.
- Provincial Engineering Research Center for Biomaterials Genome of Sichuan, Sichuan University, Chengdu, 610064, People's Republic of China.
| | - Chongqi Tu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xang, Chengdu, 610041, Sichuan, People's Republic of China.
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Li Min
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xang, Chengdu, 610041, Sichuan, People's Republic of China.
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
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Ariga A, Tanizawa T, Sato S, Funauchi Y, Matsumoto S, Ae K. Bipolar Head Perforation With Rhabdomyosarcoma of the Thigh: A Case Report With Literature Review. CANCER DIAGNOSIS & PROGNOSIS 2024; 4:71-76. [PMID: 38173666 PMCID: PMC10758845 DOI: 10.21873/cdp.10288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 11/20/2023] [Indexed: 01/05/2024]
Abstract
Background/Aim High complication rates during the perioperative management of sarcomas around the pelvis have been reported; however, few include the detailed clinical course or complications in the late postoperative period. Radiotherapy is a multidisciplinary strategy for treating sarcomas. However, irradiated bone and soft tissues show a permanent loss of repair and immunocompetence. We present a case of pleomorphic rhabdomyosarcoma of the thigh that resulted in acetabular collapse induced by radiation and intestinal perforation during long-term follow-up. Additionally, we discuss the risk factors for late complications and pelvic reconstruction methods. Case Report A 75-year-old man presented with a 1-month history of a recurring fever. Ten years prior, he was diagnosed with pleomorphic rhabdomyosarcoma of the right thigh and underwent a wide resection and bipolar hip arthroplasty, followed by chemotherapy and radiotherapy. Radiographs showed central dislocation of the bipolar head. Computed tomography revealed free air in the hip joint and thickening of the colon wall. Colonoscopy revealed displacement of the bipolar head into the colon wall. Colon resection and hip disarticulation were performed, as the bipolar head was contaminated with intestinal contents. Currently, he is able to walk stably with a walker, and there is no evidence of recurrence or metastasis of the tumor. Conclusion Irradiation of the periacetabular bone may induce resorptive destruction, resulting in future structural failure. Hardware should not be used for periacetabular bone reconstruction; the risk of pelvic organ damage should be considered when the acetabular collapse becomes deteriorated. Therefore, other reliable and permanent reconstruction options are required.
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Affiliation(s)
- Akane Ariga
- Department of Orthopedic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taisuke Tanizawa
- Department of Orthopedic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shingo Sato
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuki Funauchi
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Seiichi Matsumoto
- Department of Orthopedic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Keisuke Ae
- Department of Orthopedic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
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Zhang L, Iwata S, Saito M, Nakagawa M, Tsukushi S, Yoshida S, Gokita T, Ae K, Nakashima S, Watanuki M, Akiyama T. Hip Transposition Can Provide Early Walking Function After Periacetabular Tumor Resection: A Multicenter Study. Clin Orthop Relat Res 2023; 481:2406-2416. [PMID: 37184605 PMCID: PMC10642873 DOI: 10.1097/corr.0000000000002696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 03/23/2023] [Accepted: 04/20/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Reconstruction after periacetabular bone tumor resection involves important tradeoffs; large bone grafts or endoprostheses are reported to offer fair walking function in general but can be technically demanding and carry a high risk of severe complications. Conversely, hip transposition avoids implant-related risks, but stability and functional return may be less consistent. Fewer studies are available on hip transposition, which is also appealing in more resource-constrained environments, and little is known about the time course from surgery to functional return after hip transposition. QUESTIONS/PURPOSES (1) What is the time course of recovery of walking function after hip transposition, especially in the first 6 months? (2) What factors are associated with a greater likelihood of early functional recovery? (3) Is early (2-month) functional recovery associated with a greater likelihood of walking ability and higher Musculoskeletal Tumor Society (MSTS) scores? METHODS Between 2009 and 2019, six tertiary care centers in Japan treated 48 patients with internal hemipelvectomy for malignant tumors. During that time, the preferred reconstructive approach was hip transposition, and 92% (44 of 48) of our patients were treated with this procedure. Among them, 86% (38 of 44) had follow-up of at least 6 months, had no local recurrence during that time, and were included in our retrospective study. We chose 6 months as the minimum follow-up duration because the endpoints in this study pertained to early recovery rather than reconstructive durability. Hip transposition involved moving the proximal end of the femur (femoral head, resection end of the trochanteric area, and spacers such as prostheses) upward to the underside of the resected ilium or the lateral side of the sacrum if sacroiliac joint resection was performed. The end of the proximal femur was stabilized to the remaining ilium or sacrum using polyethylene tape, polyethylene terephthalate mesh, an iliotibial tract graft, or an external fixator, according to the surgeon's preference. The median age at surgery was 46 years (range 9 to 76 years), there were 23 women and 15 men, and the median follow-up duration was 17 months (range 6 to 110 months). The postoperative time course of functional recovery was assessed with a record review, the timing of functional milestones was identified (wheelchair, walker, bilateral crutches, single crutch or cane, and walking without an aid), and the MSTS score at the final follow-up was assessed. Additionally, demographic and surgical factors were reviewed, and their association with short-term functional recovery and the final functional outcome was analyzed. RESULTS Patients started using a walker at median postoperative day (POD) 20 (IQR 14 to 36) and with bilateral crutches at median POD 35 (IQR 20 to 57). At POD 60, which was the approximate median date of discharge, 76% (29 of 38) of patients were able to walk using bilateral crutches (the early recovery group) and 24% (nine of 38) of patients were not able to do so (the delayed recovery group). No baseline factors were different between the two groups. The early recovery group had a higher median MSTS score than the delayed recovery group: 57% (range 17% to 90%) versus 45% (13% to 57%) (p = 0.047). Moreover, more patients acquired better function (a single crutch or cane or more) in the early recovery group, with a median of 5 months (95% CI 4 to 11) than did those in the delayed recovery group (median not reached) (p = 0.0006). The HR was 15.2 (95% CI 2.5 to 93). Forty-two percent (16 of 38) underwent additional surgery for wound management. CONCLUSION It took patients a fair amount of time to recover walking function after hip transposition, and patients who could not walk on bilateral crutches at POD 60 seemed less likely to regain walking function and were likely to have lower MSTS scores thereafter. Wound-related complications were frequent. This method may be a realistic alternative for younger patients who have the strength for a long rehabilitation period or those who want to minimize prosthesis-related complications. Future studies with more patients are necessary to understand the risk factors associated with delayed recovery.Level of Evidence Level III, therapeutic study.
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Affiliation(s)
- Liuzhe Zhang
- Department of Orthopedic Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan
- Department of Orthopaedic Surgery, the University of Tokyo, Tokyo, Japan
| | - Shintaro Iwata
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Masanori Saito
- Department of Orthopedic Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Makoto Nakagawa
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Satoshi Tsukushi
- Division of Orthopaedic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Shinichiro Yoshida
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tabu Gokita
- Department of Orthopaedic Oncology, Saitama Cancer Center, Saitama, Japan
| | - Keisuke Ae
- Department of Orthopedic Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Seiya Nakashima
- Division of Orthopaedic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Munenori Watanuki
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toru Akiyama
- Department of Orthopedic Surgery, Jichi Medical University Saitama Medical Center, Saitama, Japan
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Hu X, Lu M, Zhang Y, Li Z, Wang J, Wang Y, Xing Z, Yang X, Tu C, Min L. Pelvic-girdle reconstruction with three-dimensional-printed endoprostheses after limb-salvage surgery for pelvic sarcomas: current landscape. Br J Surg 2023; 110:1712-1722. [PMID: 37824784 PMCID: PMC10638540 DOI: 10.1093/bjs/znad310] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/25/2023] [Accepted: 09/09/2023] [Indexed: 10/14/2023]
Abstract
Resection of pelvic bone tumors and the subsequent reconstruction of the pelvic girdle pose challenges due to complex anatomy, load-bearing demands, and significant defects. 3D-printed implants have revolutionized pelvic girdle reconstruction by offering customized solutions, porous surface structures for precise resection with custom guides, and improved integration. Many tertiary medical centers have adopted 3Dprinted hemipelvic endoprostheses, leading to enhanced outcomes. However, most studies are limited to single centers, with a small number of cases and short follow-up periods. Additionally, the design of these implants often relies heavily on individual experience, resulting in a lack of uniformity and significant variation. To provide a comprehensive assessment of this technology, we conducted an analysis of existing literature, encompassing tumor resection classification, various types of prosthesis design, reconstruction concepts, and post-reconstruction functional outcomes.
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Affiliation(s)
- Xin Hu
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Minxun Lu
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Yuqi Zhang
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Zhuangzhuang Li
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Jie Wang
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Yitian Wang
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Zhengyi Xing
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
- Provincial Engineering Research Center for Biomaterials Genome of Sichuan, Sichuan University, Chengdu, China
| | - Xiao Yang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
- Provincial Engineering Research Center for Biomaterials Genome of Sichuan, Sichuan University, Chengdu, China
| | - Chongqi Tu
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Li Min
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
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[Application of three-dimensional printing technology in treatment of limb bone tumors]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:790-795. [PMID: 35848172 PMCID: PMC9288913 DOI: 10.7507/1002-1892.202203006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
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.
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