CAJ | 학술논문

目的探讨计算机导航辅助髋臼周围肿瘤精确切除与个体化定制假体重建的效果. 方法选取1例左侧骨盆软骨肉瘤切除术后复发患者,男,55岁,二次术前行CT和MRI检查,利用三维图像融合技术判断髋臼周围肿瘤侵袭范围,确定外科边缘及截骨平面,根据截骨后骨盆缺损范围利用计算机辅助设计与制造(CAD/CAM)技术设计并定制个体化髋臼假体.术前将CT数据、标记的截骨范围及假体安装参数导入导航系统中进行规划,术中在导航引导下精确切除肿瘤并验证切除边界的准确性,继而在导航辅助下完成个体化定制假体的精确安装,验证假体的匹配程度.切除标本后送病理学检查,测量患肢长度变化,并参照肌肉骨骼肿瘤学会93(MSTS 93)功能评分标准评定关节功能. 结果三维图像融合技术可有效指导复杂区域肿瘤安全边界的确定.计算机导航辅助肿瘤切除和个体化定制髋臼假体重建能够满足髋臼肿瘤精准切除和重建的要求,切除边缘经病理学检查证实无肿瘤存在,导航验证及影像学证实假体安装准确,假体与截骨界面完美匹配,髋臼位置和角度理想.术后6个月假体在位良好、无松动,螺钉无断裂,肿瘤无复发、转移,无感染,MSTS93评分为16分.结论综合利用计算机导航、图像融合、逆向工程、CAD/CAM可有效实现髋臼周围肿瘤的精确切除与个体化定制髋臼假体重建,实现手术目标.
목적 탐토계산궤도항보조관구주위종류정학절제여개체화정제가체중건적효과. 방법 선취1례좌측골분연골육류절제술후복발환자,남,55세,이차술전행CT화MRI검사,이용삼유도상융합기술판단관구주위종류침습범위,학정외과변연급절골평면,근거절골후골분결손범위이용계산궤보조설계여제조(CAD/CAM)기술설계병정제개체화관구가체.술전장CT수거、표기적절골범위급가체안장삼수도입도항계통중진행규화,술중재도항인도하정학절제종류병험증절제변계적준학성,계이재도항보조하완성개체화정제가체적정학안장,험증가체적필배정도.절제표본후송병이학검사,측량환지장도변화,병삼조기육골격종류학회93(MSTS 93)공능평분표준평정관절공능. 결과 삼유도상융합기술가유효지도복잡구역종류안전변계적학정.계산궤도항보조종류절제화개체화정제관구가체중건능구만족관구종류정준절제화중건적요구,절제변연경병이학검사증실무종류존재,도항험증급영상학증실가체안장준학,가체여절골계면완미필배,관구위치화각도이상.술후6개월가체재위량호、무송동,라정무단렬,종류무복발、전이,무감염,MSTS93평분위16분.결론 종합이용계산궤도항、도상융합、역향공정、CAD/CAM가유효실현관구주위종류적정학절제여개체화정제관구가체중건,실현수술목표.
Objective To investigate the efficacy of 3D image fusion used in acetabular reconstruction with custom prosthesis after tumor en-bloc resection using computer assisted navigation.Methods The preoperative CT and MR images of a 55-year-old male patient with tumor recurrence after resection of chondrosarcoma at the left pelvis were collected for 3D image fusion.The range of tumor invasion,safe boundaries for resection and planning osteotomy plane were marked on the 3D model.A custom acetabular prosthesis was designed and manufactured using CAD/CAM techniques according to the parameters.The CT data,osteotomy boundaries marked and prosthesis fitting parameters were imported into the Computer Assisted Navigation System preoperatively for surgical planning.The tumor was accurately resected and the custom prosthesis precisely fixed with the help of navigation system according to the preoperative planning.The excision boundaries and the acetabular center position were checked.Results 3D image fusion technique made it easy and effective to define safe boundaries of tumor resection in a complicated acetabular region.Pathological examination showed absence of tumor at the margins of resection.The navigation system and X-ray evaluation indicated that the prosthesis was fixed precisely,with well-fitted interface with the bone,fine acetabular locations and angles.Conclusion Multiple digital techniques can help a great deal in precise acetabular reconstruction with a custom prosthesis after tumor en-bloc resection to achieve good pelvic stability and fine functional recovery of the hip.