中国组织工程研究

中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (13): 1987-1992.doi: 10.12307/2023.282

• 骨与关节生物力学 bone and joint biomechanics • 上一篇    下一篇

“三脚架”手术治疗髋臼转移瘤的临床疗效及生物力学分析

赖洁青1，李若愚2，何敏聪3，蓝  鋆2，杨兴富1，周楠楠1，蒋林亨1，吕  政1，易春智2，方  斌2   

  1. 1广州中医药大学第一临床医学院，广东省广州市   510405；2广州中医药大学第一附属医院五骨科，广东省广州市   510405；3广州中医药大学第三附属医院关节科，广东省广州市   510405
  • 收稿日期:2022-04-01 接受日期:2022-05-16 出版日期:2023-05-08 发布日期:2022-08-11
  • 通讯作者: 易春智，博士，主治医师，广州中医药大学第一附属医院五骨科，广东省广州市 510405 方斌，博士，主任医师，广州中医药大学第一附属医院五骨科，广东省广州市 510405
  • 作者简介:赖洁青，男，1995年生，广东省普宁市人，汉族，2022年广州中医药大学毕业，硕士，主要从事骨肿瘤与生物力学的研究。
  • 基金资助:
    国家自然科学基金面上项目(81473696)，项目负责人：方斌；国家自然科学基金青年项目(82004392)，项目负责人：何敏聪；广东省自然科学基金面上项目(2022A1515011379)，项目负责人：方斌

Clinical efficacy and biomechanical analysis of the tripod percutaneous reconstruction technique in periacetabular lesions caused by metastatic cancer

Lai Jieqing1, Li Ruoyu2, He Mincong3, Lan Yun2, Yang Xingfu1, Zhou Nannan1, Jiang Linheng1, Lyu Zheng1, Yi Chunzhi2, Fang Bin2   

  1. 1The First Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangzhou 510405, Guangdong Province, China; 2Fifth Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China; 3Department of Orthopedics, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • Received:2022-04-01 Accepted:2022-05-16 Online:2023-05-08 Published:2022-08-11
  • Contact: Yi Chunzhi, MD, Attending physician, Fifth Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China Fang Bin, MD, Chief physician, Fifth Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • About author:Lai Jieqing, Maser, The First Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • Supported by:
    the National Natural Science Foundation of China, No. 81473696 (to FB); the National Natural Science Foundation of China (Youth Project), No. 82004392 (to HMC); General Project of the Natural Science Foundation of Guangdong Province, No. 2022A1515011379 (to FB)

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摘要：

文题释义：
经皮三脚架髋臼支撑手术：使用3枚空心螺钉——前柱螺钉、后柱螺钉、跨柱螺钉以空间稳定结构对髋臼进行支撑的微创手术，使髋臼转移瘤患者减轻疼痛、术后快速负重与早期辅助治疗。
三维模型有限元分析：此方法需患者 CT 数据 DICOM 格式，不仅能在模型上清晰地看出骨盆转移瘤特点，还能模拟三脚架固定手术和力学稳定性的分析，从而为临床提供理论基础。

背景：从既往的报道可知，经皮三脚架髋臼支撑手术可以实现快速改善骨盆转移瘤疼痛、恢复髋关节活动功能的临床目的。
目的：进一步探讨经皮三脚架髋臼支撑手术的临床疗效及生物力学机制。
方法：回顾性地纳入广州中医药大学第一附属医院4例5髋髋臼转移瘤患者的临床资料，运用东部合作肿瘤组织评分(ECOG)和目测类比评分进行疗效评价；并利用三维有限元技术构建骨盆-股骨近端三维有限元模型，设定空白组为正常髋臼，模型组为患侧髋臼，治疗组为患侧术后髋臼，观察3组的应力区域情况，分析经皮三脚架髋臼支撑手术的生物力学原理机制。
结果与结论：①患者资料分析：4例患者术后的ECOG和疼痛目测类比评分均明显好转(P < 0.05)；4例患者中术后1例可以自由行走，2例由卧床分别转为借助单拐和助行器行走，1例仍使用助行器行走。②有限元分析：与空白组相比，模型组的髋臼局部应力上升(P < 0.05)，提示患侧髋臼稳定性较差、应力集中明显，骨质遭受破坏后承载应力效果不佳；与模型组相比，治疗组髋臼局部应力下降(P < 0.05)，提示髋臼受侵袭区域三脚架可以承载应力并使髋臼的应力集中得到缓解；对比空白组与治疗组(P > 0.05)，可知术后髋臼的应力集中情况得到缓解，达到术前正常骨质的支撑应力效果。③结论：三脚架手术是一种为髋臼转移瘤患者提供安全有效的疼痛缓解并允许早期负重和全身治疗的新技术，该技术给髋臼提供稳定的力学支撑，但其远期临床疗效仍需长期随访评估。

https://orcid.org/0000-0003-4162-8016 (赖洁青) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 髋臼转移瘤, 经皮三脚架髋臼支撑手术, 微创手术, 三维有限元分析, 螺钉, 骨盆, 生物力学, 疼痛

Abstract: BACKGROUND: Previous reports have shown that percutaneous tripod acetabular support surgery can quickly improve the pain of pelvic metastases and restore the function of hip joint.  
OBJECTIVE: To further explore the clinical efficacy and biomechanical mechanism of percutaneous tripod acetabular support surgery.
METHODS: This study retrospectively included four patients with five acetabular metastases from the First Affiliated Hospital of Guangzhou University of Chinese Medicine, and used Eastern Cooperative Oncology Group (ECOG) and visual analogue scale scores to evaluate the efficacy. Three-dimensional finite element model of pelvis-proximal femur was constructed using three-dimensional finite element technology. The normal group was set as the normal acetabulum; the model group as the affected side acetabulum; and the treatment group as postoperative acetabulum on the affected side. The stress areas of the three groups were observed to analyze the biomechanical principles and mechanisms of percutaneous tripod acetabular support surgery.  
RESULTS AND CONCLUSION: (1) Data analysis: Postoperative ECOG and visual analogue scale pain scores were significantly improved (P < 0.05) in four patients. Among the four patients, one case could walk freely; two cases changed from bed rest to walking with crutches and walkers, and one case still used walkers to walk. (2) Finite element analysis: Compared with the blank group, the local stress of the acetabulum in the two-legged standing position in the model group increased (P < 0.05) , indicating that the stability of the affected acetabulum was poor; the stress concentration was obvious, and the bearing stress effect was not good after the bone in the tumor area was destroyed. Compared with the model group, the stress in the acetabulum in the two-foot standing position in the treatment group decreased (P < 0.05), indicating that the tripod in the affected area of the acetabulum could bear the stress and relieve the stress concentration in the acetabulum and tumor area. Comparing the blank group and the treatment group, it could be seen that the stress concentration of the acetabulum was relieved after operation, and the support brought by the tripod structure was able to achieve the support stress effect of normal bone (P > 0.05). (3) It is concluded that tripod surgery is a new technique for providing safe and effective pain relief for acetabular metastases. This technique provides stable mechanical support for the acetabulum, but its long-term clinical efficacy still needs long-term follow-up evaluation.

Key words: acetabular metastases, percutaneous tripod acetabular support surgery, minimally invasive surgery, three-dimensional finite element analysis, screw, pelvis, biomechanics, pain

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