Recently, Dr Zhang Guofeng, Deputy Chief Physician of the Department of Bone Oncology, Yantai Affiliated Hospital of Binzhou Medical College, and his team successfully applied LDK custom-made tumor prosthesis and performed the very difficult "custom-made femoral tumor prosthesis replacement" surgery on a patient with complex condition, which not only marked the breakthrough development of the Department of Bone Oncology, Yantai Affiliated Hospital of Binzhou Medical College, in the treatment of malignant bone tumor but also represented its high level surgery skills had reached the domestic advanced level.
Description of the condition
Patient, female, age 70
A year ago the patient developed painful symptoms in her right thigh, which gradually worsened. The patient thought she had femoral head necrosis, but the pain remained intense after taking painkillers. Recently, she consulted Yantai Affiliated Hospital of Binzhou Medical College since the pain became so severe that she could not sleep at night or walk anymore.
The MRI of her joint suggested extensive abnormal signal in the proximal end of the right femur, and tumor lesion was considered. The patient was then admitted to Department of Bone Oncology for further treatment.
After detailed examination, the team of deputy chief physician Zhang Guofeng confirmed the diagnosis of metastatic tumor in the right femur, and the primary lesion was considered to be peripheral lung cancer. After full communication with the patient and her family, surgery was decided.
Challenge Accept! Medical-industrial Integration for difficult replacement surgery
The toughest problem for doctors was that the patient was 70 years old and the right upper and middle femur had been extensively destroyed by tumor erosion, even the distal femur that had not been eroded was not left much neither, so the conventional reconstruction methods after tumor resection were no longer applicable. After repeated simulations and discussion, Dr. Zhang Guofeng's team decided to perform tumor resection of the upper and middle femur + customized tumor prosthesis replacement.
Preoperative MRI
Preoperative CT
Difficulty Inventory
1.
The first difficulty must be faced for this procedure is whether the patient can safely tolerate the surgery considering her 70 years old age, malignant tumor and poor physical condition.
2.
The second difficulty is that the operation involves extensive resection of the tumor and reconstruction of the limb, long operation time, massive bleeding that may cause hemorrhagic shock, and high probability of infection.
3.
The distal segment of the femur, which is not eroded, is too short to hold the medullary pin of the prosthesis, so how to design a safe and effective prosthesis for reconstruction is the third challenge.
4.
Since the upper and middle femoral segments were replaced by removing the upper and middle femoral bone tissues (including the femoral head) and the muscle stops that drive the hip joint, how to reconstruct the soft tissues around the prosthesis and restore the function of the limb was the fourth challenge in this surgery.
Dr. Zhang Guofeng, the deputy chief surgeon, firstly communicated with the team of LDK tumor prosthesis engineers to design a customized tumor prosthesis. Due to the high level of this surgery and the difficulty as well as risk of the operation, multidisciplinary consultation and discussion were organized with experts from the Department of Pathology, Department of Imaging, Department of Respiratory Medicine, Department of Cardiovascular Medicine, Oncology Center and Department of Anesthesiology to analyze the condition and determine the treatment plan.
Prosthesis Design Solution
1). 3D reconstruction of image data 3D reconstruction of the patient's bone model based on the imaging data.
2). Prosthesis design plan and effect sample after replacement
replacement effect sample
Customized prosthesis and resected tumor segments
After thorough preparation, with the tacit cooperation of the medical and nursing staffs of the anesthesia department and the operation room, Dr. Zhang Guofeng, the deputy chief surgeon, successfully performed "upper and middle femoral tumor resection + customized tumor prosthesis replacement" for the patient.
Postoperative X-Ray
The operation was performed to meet the objectives of removing tumor bone, relieving patient's pain, restoring limb function and improving quality of life to the maximum extent. After careful diagnosis and care by all medical and nursing staff of the Department of Bone Oncology, the patient recovered very well and was discharged from the hospital. The severe pain in the thigh that had been bothering the patient for a long time was solved, and the patient resumed normal walking after the operation and was very satisfied with the treatment effect.
Tips from Dr. Zhang Guofeng, Deputy Chief Physician
Most malignant tumors can develop bone metastases. Bone metastases have local pain as the main clinical manifestation, which is insidious and not easily detected in time, and can easily cause serious bone destruction and even pathological fracture. Initially, patients often mistake it for common arthritis, but later it develops into severe pain, especially persistent night pain. Here we especially remind that when the above symptoms appear, it is necessary to go to regular hospital for medical treatment in time, and if necessary, X-ray, CT and MRI examinations can be performed to detect most of the skeletal tumor diseases. Once bone metastases are suspected, it is important to go to a specialized bone tumor center for consultation and treatment.
Post time: Oct-24-2022