中华创伤骨科杂志
中華創傷骨科雜誌
중화창상골과잡지
CHINESE JOURNAL OF ORTHOPAEDIC TRAUMA
2011年
12期
1143-1147
,共5页
郭征%付军%王臻%栗向东%李靖%范宏斌%陈国景%吴智钢%裴延军%袁超凡
郭徵%付軍%王臻%慄嚮東%李靖%範宏斌%陳國景%吳智鋼%裴延軍%袁超凡
곽정%부군%왕진%률향동%리정%범굉빈%진국경%오지강%배연군%원초범
外科手术%计算机辅助%骨肿瘤%修复外科手术
外科手術%計算機輔助%骨腫瘤%脩複外科手術
외과수술%계산궤보조%골종류%수복외과수술
Surgcry,computer-assisted%Bone neoplasms%Reconstructive surgical procedures
目的 通过应用计算机导航系统辅助骨肿瘤术前设计、切除与重建,探讨骨肿瘤精确切除和重建的安全性与有效性. 方法 2009年2月至2011年8月,实施计算机导航辅助外科治疗骨肿瘤患者39例,其中男21例,女18例,年龄16～59岁,平均36.6 岁;肿瘤发生于骨盆区20例,股骨远端9例,胫骨近端6例,脊柱4例.术前利用计算机导航系统将CT和MRI的.dicom数据进行分析处理,精确显示骨肿瘤边界并标定,设计肿瘤切除范围,术中在导航引导下进行骨肿瘤的精确切除,并根据术前设计选择肿瘤关节假体或同种异体骨进行骨结构重建.术后评价肿瘤局部控制情况,按照MSTS93功能评价标准进行功能评定.结果 术中解剖注册点与术前三维虚拟CT影像匹配性好,平均注册误差为0.52 mm(0.4～0.7 mm).36例患者按术前设计切除肿瘤并采用同种异体骨或人工假体重建骨缺损区.术中未发生神经血管和脏器损伤,肿瘤标本边缘病理检查显示切缘清洁无肿瘤.所有患者随访3～32个月,平均19.5个月.5例恶性肿瘤局部复发,其中骨盆3例,肢体2例；肺转移3例.MSTS93功能评分为24.8分(22 ～ 28分). 结论 计算机导航辅助骨肿瘤切除与重建是一种安全、有效的方法,有利于避免肿瘤切除的盲目性和重建的随意性,减少肿瘤复发,提高功能效果.
目的 通過應用計算機導航繫統輔助骨腫瘤術前設計、切除與重建,探討骨腫瘤精確切除和重建的安全性與有效性. 方法 2009年2月至2011年8月,實施計算機導航輔助外科治療骨腫瘤患者39例,其中男21例,女18例,年齡16～59歲,平均36.6 歲;腫瘤髮生于骨盆區20例,股骨遠耑9例,脛骨近耑6例,脊柱4例.術前利用計算機導航繫統將CT和MRI的.dicom數據進行分析處理,精確顯示骨腫瘤邊界併標定,設計腫瘤切除範圍,術中在導航引導下進行骨腫瘤的精確切除,併根據術前設計選擇腫瘤關節假體或同種異體骨進行骨結構重建.術後評價腫瘤跼部控製情況,按照MSTS93功能評價標準進行功能評定.結果 術中解剖註冊點與術前三維虛擬CT影像匹配性好,平均註冊誤差為0.52 mm(0.4～0.7 mm).36例患者按術前設計切除腫瘤併採用同種異體骨或人工假體重建骨缺損區.術中未髮生神經血管和髒器損傷,腫瘤標本邊緣病理檢查顯示切緣清潔無腫瘤.所有患者隨訪3～32箇月,平均19.5箇月.5例噁性腫瘤跼部複髮,其中骨盆3例,肢體2例；肺轉移3例.MSTS93功能評分為24.8分(22 ～ 28分). 結論 計算機導航輔助骨腫瘤切除與重建是一種安全、有效的方法,有利于避免腫瘤切除的盲目性和重建的隨意性,減少腫瘤複髮,提高功能效果.
목적 통과응용계산궤도항계통보조골종류술전설계、절제여중건,탐토골종류정학절제화중건적안전성여유효성. 방법 2009년2월지2011년8월,실시계산궤도항보조외과치료골종류환자39례,기중남21례,녀18례,년령16～59세,평균36.6 세;종류발생우골분구20례,고골원단9례,경골근단6례,척주4례.술전이용계산궤도항계통장CT화MRI적.dicom수거진행분석처리,정학현시골종류변계병표정,설계종류절제범위,술중재도항인도하진행골종류적정학절제,병근거술전설계선택종류관절가체혹동충이체골진행골결구중건.술후평개종류국부공제정황,안조MSTS93공능평개표준진행공능평정.결과 술중해부주책점여술전삼유허의CT영상필배성호,평균주책오차위0.52 mm(0.4～0.7 mm).36례환자안술전설계절제종류병채용동충이체골혹인공가체중건골결손구.술중미발생신경혈관화장기손상,종류표본변연병리검사현시절연청길무종류.소유환자수방3～32개월,평균19.5개월.5례악성종류국부복발,기중골분3례,지체2례；폐전이3례.MSTS93공능평분위24.8분(22 ～ 28분). 결론 계산궤도항보조골종류절제여중건시일충안전、유효적방법,유리우피면종류절제적맹목성화중건적수의성,감소종류복발,제고공능효과.
Objective To analyze the security and effectiveness of computer-assisted navigation used in the preoperative design,accurate resection and reconstruction of bone tumor. Methods From February 2009 to August 2011,tumor resections and reconstructions assisted by computer-assisted navigation were performed in 39 patients with musculoskeletal tumor.They were 21 males and 18 females.Tumors occurred in the pelvis in 20 cases,in the distal femur in 9.in the proximal tibia in 6 and in the spine in 4.The preoperative CT scans and MRI images of all patients were transformed into data at.dicom format and imported into the navigation system.The computer analyzed the data,reconstrueted the anatomical structure of the tumor,displayed and marked the accurate border of the tumor.After the area was defined,resection of the bonc tumor was perfomed strictly under the guidance of navigation,and reconstruction accomplished with the proper prostheses or allograft bones preoperatively designed.The local recurrence of tumor and surgical margin were appraised postoperatively.and the function was assessed according to MSTS93 evaluation system.Results The intraoperative anatomic registration points were coincident with those by the preoperativu design,with an average crror of 0.52mm (from 0.4to 0.7mm).Accurate tumor resection and satisfactory reconstruction were performed on schedule in 36 patients,without intraoperative injury to nerves,vessels or organs.The pathological tumor samples showed satisfactory surgical margins without residual tumor.The avcrage follow-up was 19.5 months (range,3 to 32 months).Local recurrence was found in 5 malignant cases,including 3 pelvic and 2 limb cases as well as 3 cases of pulmonary metastasis.The average MSTS93 functional soore was 24.8 (from 22 to 28) points. Conclusions Computer-assisted navigation system is a safe and effectiv assistance for accurate resection and reconstruction of musculoskeletal tumor.It helps avoiding blindness in tumor resection and arbitrary reconstrution.It can also reduce the recurrence rate and improve functional recoveru.
