长骨恶性肿瘤切除后重建方式的研究进展

Research Progress on Reconstruction Methods after Resection of Malignant Tumors of Long Bones

摘要: 在新辅助化疗、放疗及影像学技术不断进步的背景下，四肢长骨恶性肿瘤保肢治疗已取得显著成效，在病人条件许可的情况下，保肢手术与截肢手术的5年生存率无区别。长骨恶性肿瘤切除后残留的大段骨缺损(长度 > 5 cm)难以自行修复，需要进行人工重建，当前重建方法可大致分为生物重建与机械重建两大类。3D打印假体作为机械重建方式之一，可实现高精度适配与瞬时稳定，具备骨长入能力的多孔设计，同步实现生物学整合与力学支撑，但临床实践案例相对匮乏。生物医用材料，融合新型生物材料的创新修复技术，针对骨缺损的治疗展现出突出的临床潜力。Masquelet与Ilizarov技术展现出突出的临床潜力。该文概括了现阶段长骨肿瘤切除后重建方法的研究现状，汇总了3D打印假体与新材料的应用，剖析了各项技术的强项与短板，同时展望了研究方向。长骨恶性肿瘤切除后大段骨缺损重建方式多种多样，每种方式都有其优缺点，重建方式的选择主要依赖医师的经验，本文就分析各种重建方式，以期为临床提供参考。

Abstract: Amid ongoing advancements in neoadjuvant chemotherapy, radiotherapy, and imaging techniques, limb salvage treatment for malignant tumors of the long bones has yielded significant outcomes. When patient conditions allow, the 5-year survival rates for limb salvage surgery and amputation surgery are comparable. Large bone defects (length > 5 cm) that persist following the resection of malignant long bone tumors are challenging to repair autonomously and necessitate artificial reconstruction. Presently, reconstruction methods can be broadly categorized into two primary types: biological reconstruction and mechanical reconstruction. 3D printed prostheses represent a notable mechanical reconstruction method that offers high-precision adaptation and immediate stability. These prostheses feature a porous design conducive to bone growth and facilitate both biological integration and mechanical support. Despite their advantages, clinical applications remain limited. Innovative repair technologies that incorporate new biomaterials have shown significant clinical promise in addressing bone defects. The Masquelet and Ilizarov techniques also exhibit considerable potential in clinical settings. This article reviews the current state of research on post-resection reconstruction methods for long bone tumors, compiles the applications of 3D printed prostheses and novel materials, and analyzes the strengths and weaknesses of each technology while anticipating future research directions. Various methods exist for reconstructing large bone defects following the resection of malignant long bone tumors, each presenting distinct advantages and disadvantages. The selection of a reconstruction method primarily relies on the physician’s experience. This article aims to analyze these reconstruction methods to serve as a reference for clinical practice.