CAJ | 학술논문

目的探讨计算机导航骨盆肿瘤精确切除与重建的安全性和有效性,评价有限元力学分析辅助骨盆环结构与力学重建的可行性.方法 2008年12月至2010年6月,采用有限元分析辅助肿瘤切除后的组配式假体设计,并通过计算机导航对12例内半骨盆恶性肿瘤患者行肿瘤切除与重建术.男8例,女4例;年龄25～53岁,平均39.7岁.软骨肉瘤4例,成骨肉瘤2例,Ewing肉瘤2例,恶性纤维组织细胞瘤1例,转移瘤3例(肾癌1例、甲状腺癌1例、乳腺癌1例).Enneking原发恶性肿瘤分期:ⅠA期1例,Ⅰ B期2例,ⅡA期2例,ⅡB期4例.术后评价肿瘤学结果和功能恢复情况.结果术中未发生神经、血管和脏器损伤.术后X线片显示肿瘤切除范围与术前计划匹配,肿瘤切除彻底,组配式骨盆假体安放位置满意,固定钉位置满足术前有限元力学分析要求.全部病例随访8～26个月,平均18.2个月.肿瘤局部复发并肺转移1例,深部感染1例,深静脉血栓形成1例.无假体脱位及内固定松动、断裂,无肢体短缩.术后6个月时1993年美国骨肿瘤学会功能评分平均70%,6例随访超过20个月的患者功能评分平均68%.结论计算机导航辅助骨盆肿瘤切除重建是一种安全有效的方法,有限元分析可为骨盆环重建提供精确的力学指导.
목적 탐토계산궤도항골분종류정학절제여중건적안전성화유효성,평개유한원역학분석보조골분배결구여역학중건적가행성.방법 2008년12월지2010년6월,채용유한원분석보조종류절제후적조배식가체설계,병통과계산궤도항대12례내반골분악성종류환자행종류절제여중건술.남8례,녀4례;년령25～53세,평균39.7세.연골육류4례,성골육류2례,Ewing육류2례,악성섬유조직세포류1례,전이류3례(신암1례、갑상선암1례、유선암1례).Enneking원발악성종류분기:ⅠA기1례,Ⅰ B기2례,ⅡA기2례,ⅡB기4례.술후평개종류학결과화공능회복정황.결과 술중미발생신경、혈관화장기손상.술후X선편현시종류절제범위여술전계화필배,종류절제철저,조배식골분가체안방위치만의,고정정위치만족술전유한원역학분석요구.전부병례수방8～26개월,평균18.2개월.종류국부복발병폐전이1례,심부감염1례,심정맥혈전형성1례.무가체탈위급내고정송동、단렬,무지체단축.술후6개월시1993년미국골종류학회공능평분평균70%,6례수방초과20개월적환자공능평분평균68%.결론 계산궤도항보조골분종류절제중건시일충안전유효적방법,유한원분석가위골분배중건제공정학적역학지도.
Objective To analyze the security and effectiveness of the accurate resection and reconstruction of pelvic tumor with computer navigation and to evaluate the feasibility of pelvic ring structure and mechanics reconstruction using finite element analysis.Methors From December 2008 to June 2010,tumor resections assisted by computer navigation technology and pelvic reconstructions with assembly prosthesis designed by finite element analysis were performed in 12 patients with internal hemi-pelvic malignant tumors.There were 8 male and 4 female patients,with the average age of 39.7 years(range,25-53).The malignant tumors involved chondrosarcoma(4 cases),osteosarcoma(2),Ewing sarcoma(2),malignant fibrohistiocytoma(1),and metastatic tumor(3,in which including renal cell carcinoma 1 case,thyroid carcinoma 1,and breast carcinoma 1).According to Enneking staging classification,there were 1 case in Ⅰ A,2 cases in ⅠB,2 cases in Ⅱ A.and 4 cases in Ⅱ B.The local recurrence of tumor and functional results were followed up postoperatively.Results There were no nerves,vessels and pelvic organs injuries intra-operatively.The postoperative X-rays showed that the excised regions were proper to the preoperative schedule and en bloc resections were performed in all patients.All assembly prostheses were in satisfactory position.and the screw fixation was accordance with the finite element biomechanical analysis.All the cases were followed up for average 18.2 months (range,8-26).There were 1 case with local recurrence and pulmonary metastasis,1 case with deep infection,and 1 case with deep vein thrombosis.No prosthesis dislocation,loosening,breaking,and limb length discrepancy occurred in all patients.The average MSTS93 functional score was 70%in all patients at 6 months,and 68 % in 6 patients at 20 months follow.up.Conclusion The resection and reconstruction of pelvic tumor assisted by computer navigation is a safe and effective procedure.The finite element analysis can provide accurate biomechanical guidance to the reconstruction of pelvic ring.