Clinical application of digitally customized and individualized titanium alloy sternal prosthesis in reconstruction of chest wall defect after radical resection of sternum tumor
Hu Haifeng1, Wang Xin2, Nie Zhihao1, Liu Gaoli1, Zhang Wenhan1, Long Xinglin1, Huang Jie1, Xie Songping1
1Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, China; 2Nanyang Central Hospital, Nanyang 473000, China
Abstract：Objective This study aimed to explore the feasibility of using a digitally customized and individualized titanium alloy sternal prosthesis to reconstruct chest wall defects in patients with radical resection of sternal tumors. Methods A case series study of the relevant case data of five patients with primary sternal tumors, who were admitted to the Thoracic Surgery Department of Renmin Hospital of Wuhan University from August 2020 to October 2021, was conducted. All patients were male, aged 23-60 years (average age of 43.5 years). The cases included manubrium sternal tumor (one case) and mesosternal tumor (four cases). On the basis of the preoperative thoracic CT scan data of patients, 3D printing technology was used to construct 1∶1 three-dimensional bone and tumor models of the patients' sternum and part of the ribs and clavicle connected to it. Meanwhile, a personalized titanium alloy sternum prosthesis was designed and digitally customized. Tumor resection was simulated on the 3D printed model. Then, the titanium alloy prosthesis was implanted into the defect sternum model to match, and the prosthesis implantation was simulated. In the whole group, radical resection of sternal tumor was performed under general anesthesia, and the digitally customized and individualized titanium alloy sternal prosthesis was implanted to repair the sternal defect. Autologous tendon was used for reconstructed sternoclavicular articulation in the case of manubrium sternal tumor. Operative time, intraoperative blood loss, perioperative death, postoperative chest wall stability and chronic pain, patients' survival status, shoulder joint function in patients with sternoclavicular joint reconstruction, and postoperative complications such as sternal prosthesis displacement or rupture, pleural effusion, and lung infection were observed. Results The operation of the five cases went smoothly. No perioperative death or unplanned reoperation occurred. The operation time was 115-165 min, and the intraoperative blood loss was 80-260 mL. The postoperative pathological types included giant cell tumor of the bone (one case), myeloid sarcoma (one case), chondrosarcoma (two cases), and solitary plasmacytoma (one case). Performing musculocutaneous flap transfer to repair the chest wall was not necessary in all cases. The surgical incisions all healed well, and no implant infection occurred. The chest wall was intact and stable, and no chest wall floating nor abnormal breathing was observed. In one case, the removal of the chest tube was delayed due to pleural effusion. The longest postoperative follow-up of the whole group was 24 months, and the minimum was 12 months. The whole group had no implant fracture, displacement, pleural effusion, pulmonary infection, chronic pain, and other complications. In the case of manubrium sternal tumor, the function of sternoclavicular articulation had no disorder after reconstruction. Conclusion A digitally customized and individualized titanium alloy sternal prosthesis was used for the reconstruction of chest wall defect after radical resection of sternal tumor. This surgical scheme is feasible and easy to operate, with good postoperative chest wall stability and few complications. It deserves further clinical exploration.
胡海丰, 王新, 聂志浩, 刘高利, 张文涵, 龙杏林, 黄杰, 谢颂平. 数字化定制个体化钛合金胸骨假体在胸骨肿瘤根治性切除胸壁缺损重建术中的临床应用[J]. 中华解剖与临床杂志, 2023, 28(4): 245-250.
Hu Haifeng, Wang Xin, Nie Zhihao, Liu Gaoli, Zhang Wenhan, Long Xinglin, Huang Jie, Xie Songping. Clinical application of digitally customized and individualized titanium alloy sternal prosthesis in reconstruction of chest wall defect after radical resection of sternum tumor. Chinese Journal of Anatomy and Clinics, 2023, 28(4): 245-250.
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