中国组织工程研究与临床康复
中國組織工程研究與臨床康複
중국조직공정연구여림상강복
JOURNAL OF CLINICAL REHABILITATIVE TISSUE ENGINEERING RESEARCH
2010年
17期
3104-3108
,共5页
涂强%丁焕文%刘宝%王虹%易灿%沈健坚%曾锁林%徐国洲%刘辉亮%王少华
塗彊%丁煥文%劉寶%王虹%易燦%瀋健堅%曾鎖林%徐國洲%劉輝亮%王少華
도강%정환문%류보%왕홍%역찬%침건견%증쇄림%서국주%류휘량%왕소화
计算机辅助设计%髋臼肿瘤%个体化假体%异体半骨盆%髋关节置换
計算機輔助設計%髖臼腫瘤%箇體化假體%異體半骨盆%髖關節置換
계산궤보조설계%관구종류%개체화가체%이체반골분%관관절치환
背景:髋臼恶性肿瘤切除重建的主要目的是在安全边缘切除肿瘤并最大限度获得骨盆稳定及下肢行走的功能.既往多是通过MRI、CT、X射线片等二维资料评估切除范围,具有相当的主观性,缺乏术前设计.计算机三维重建可从整体及各个切面评估肿瘤侵蚀范围,从而做到精确确定肿瘤切除的范围.目的:评估计算机辅助设计在髋臼恶性肿瘤治疗中的应用价值.方法:1例髋臼血管肉瘤患者,应用薄层CT扫描获取病变部位的二维数据,计算机三维重建解剖学模型,设计截骨范围、个体化髋臼假体及模拟手术过程.按照计算机辅助设计方案切除髋臼肿瘤组织,采用异体半骨盆+个体化全髋关节置换重建骨盆环及右髋关节.结果与结论:异体半骨盆+个体化全髋关节置换后2个月患者开始扶拐患肢不负重行走,6个月患者行走步态基本正常,右髋关节活动良好,无疼痛不适.置换后X射线片提示人工假体与骨盆匹配良好.置换后仅右髋关节外侧有少许皮肤麻木,无深静脉血栓、假体脱位、松动等并发症.提示计算机辅助设计在髋臼周围肿瘤的治疗中有着广阔应用前景,它使手术治疗提升到个体化治疗阶段,使手术更精确、更可靠、更方便,效果更佳.
揹景:髖臼噁性腫瘤切除重建的主要目的是在安全邊緣切除腫瘤併最大限度穫得骨盆穩定及下肢行走的功能.既往多是通過MRI、CT、X射線片等二維資料評估切除範圍,具有相噹的主觀性,缺乏術前設計.計算機三維重建可從整體及各箇切麵評估腫瘤侵蝕範圍,從而做到精確確定腫瘤切除的範圍.目的:評估計算機輔助設計在髖臼噁性腫瘤治療中的應用價值.方法:1例髖臼血管肉瘤患者,應用薄層CT掃描穫取病變部位的二維數據,計算機三維重建解剖學模型,設計截骨範圍、箇體化髖臼假體及模擬手術過程.按照計算機輔助設計方案切除髖臼腫瘤組織,採用異體半骨盆+箇體化全髖關節置換重建骨盆環及右髖關節.結果與結論:異體半骨盆+箇體化全髖關節置換後2箇月患者開始扶枴患肢不負重行走,6箇月患者行走步態基本正常,右髖關節活動良好,無疼痛不適.置換後X射線片提示人工假體與骨盆匹配良好.置換後僅右髖關節外側有少許皮膚痳木,無深靜脈血栓、假體脫位、鬆動等併髮癥.提示計算機輔助設計在髖臼週圍腫瘤的治療中有著廣闊應用前景,它使手術治療提升到箇體化治療階段,使手術更精確、更可靠、更方便,效果更佳.
배경:관구악성종류절제중건적주요목적시재안전변연절제종류병최대한도획득골분은정급하지행주적공능.기왕다시통과MRI、CT、X사선편등이유자료평고절제범위,구유상당적주관성,결핍술전설계.계산궤삼유중건가종정체급각개절면평고종류침식범위,종이주도정학학정종류절제적범위.목적:평고계산궤보조설계재관구악성종류치료중적응용개치.방법:1례관구혈관육류환자,응용박층CT소묘획취병변부위적이유수거,계산궤삼유중건해부학모형,설계절골범위、개체화관구가체급모의수술과정.안조계산궤보조설계방안절제관구종류조직,채용이체반골분+개체화전관관절치환중건골분배급우관관절.결과여결론:이체반골분+개체화전관관절치환후2개월환자개시부괴환지불부중행주,6개월환자행주보태기본정상,우관관절활동량호,무동통불괄.치환후X사선편제시인공가체여골분필배량호.치환후부우관관절외측유소허피부마목,무심정맥혈전、가체탈위、송동등병발증.제시계산궤보조설계재관구주위종류적치료중유착엄활응용전경,타사수술치료제승도개체화치료계단,사수술경정학、경가고、경방편,효과경가.
BACKGROUND: Acetabular malignant tumor reconstruction is to obtain pelvic stability and lower limb walking function to excise the tumor at safe margin.Excision range has been evaluated by MRI,CT,X-ray,which are subjective and lack preoperative design.Computer-aided three-dimensional reconstruction can evaluate tumor erosion range from all planes to accurately excise the tumor.OBJECTIVE: To evaluate the value of computer aided design in the treatment of acetabular malignant tumor.METHODS: One case with acetabular hemangiosarcoma was checked with lamellar CT scanning,which acquired some two-dimensional data in disease area.The three-dimensional reconstruction of anatomical model,design of cutting bone extent,design of individual prosthesis and sham operation were made by computer.Based on computer aided design proposal,acetabular tumor was resected,pelvic ring and right hip articulation were reconstructed with allogeneic semi-pelvis and individual total hip replacement.RESULTS AND CONCLUSION: The patient began to non-weight bearing walk with double crutches 2 months after operation.At6 months,the patient walked normally.The right hip joint motion was good with no pain.Postoperative X-ray film displayed individual prosthesis matched to pelvis.The patient fell a little numbness of skin in the lateral of right hip.No phlebothrombosis,prosthesis loosening or dislocation was found.Computer aided design has a good perspective of application in the treatment of acetabular malignant tumor.Individualized treatment can improve operation accuracy,reliability,convenience and curative effect.
