计算机辅助骨盆肿瘤精确切除和功能重建  

COMPUTER-AIDED PRECISE RESECTION OF PELVIC TUMOR AND FUNCTION RECONSTRUCTION

作　　者：丁焕文[1,2] 易灿[1] 涂强[1] 王虹[1] 刘辉亮[1] 曾锁林[1] 刘宝[1] 沈健坚[1] 王迎军[2] 

机构地区：[1]广州军区广州总医院华侨科,广州510010 [2]华南理工大学材料科学与工程学院

出　　处：《中国修复重建外科杂志》2011年第10期1218-1223,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(30571897);广东省科技攻关项目(2002A3020205);广州市科技攻关项目(2008Z1-D131);广东省教育部产学研结合项目资助(2009B090300454)~~

摘　　要：目的探讨计算机辅助设计(computer-aided design,CAD)在确定骨盆肿瘤切除边界、重建骨盆和髋关节结构中的应用价值。方法 2006年11月-2009年4月收治5例骨盆肿瘤患者。男3例,女2例;年龄24～62岁,平均36.4岁。骨肉瘤、骨巨细胞瘤、血管肉瘤各1例,软骨肉瘤2例。根据Enneking骨盆肿瘤分区:Ⅰ区、Ⅰ+Ⅱ区、Ⅲ区、Ⅳ区、Ⅰ+Ⅳ区各1例。按反求工程的基本原理,采用CT、MRI扫描获取患者骨盆二维数据,计算机三维重建建立骨盆解剖模型,将解剖模型输入CAD软件精确界定肿瘤切除范围,并设计个性化辅助手术模板、个性化假体以及模拟肿瘤切除、骨缺损修复重建过程。术中按照CAD方案精确切除骨盆肿瘤组织,采用外形匹配的同种异体髂骨加内固定或同种异体髂骨加个性化假体修复肿瘤切除后骨缺损,重建骨盆。结果 5例患者均顺利完成手术,手术时间平均7.9 h,术中出血量平均3 125 mL。术后1例出现切口内积血,1例出现脑脊液漏,均对症处理后痊愈。5例均获随访,随访时间24～50个月,平均34.5个月。患者均于术后4～6周扶双拐部分负重行走,3～6个月恢复行走功能。2例于术后18个月局部复发,1例行局部肿瘤再切除术、1例行局部放疗,无再复发。术后24个月采用国际保肢学会(ISOLS)推荐的骨肿瘤保肢术疗效评价标准进行功能评定,获优2例,良3例。结论采用CAD设计的个性化辅助手术模板、个性化假体及模拟手术过程,保证了骨盆肿瘤切除的精确性和可靠性,将骨盆肿瘤的切除和功能重建提升到个体化治疗阶段,可获得较好的疗效。Objective To investigate the value of computer-aided design（CAD） in defining the resection boundary,reconstructing the pelvis and hip in patients with pelvis tumors.Methods Between November 2006 and April 2009,5 cases of pelvis tumors were treated surgically using CAD technology.There were 3 males and 2 females with an average age of 36.4 years（range,24-62 years）.The cause was osteosarcoma,giant cell tumor of bone,and angiosarcoma in 1 case,respectively,and chondrosarcoma in 2 cases.According to the Enneking system for staging benign and malignant musculoskeletal tumors,regions I,I ＋ II,III,IV,and I ＋ IV is in 1 case,respectively.According to the principle of reverse engineering,5 patients with pelvis tumors were checked with lamellar CT/MRI scanning,whose two-dimensional data were obtained in disease area.The three-dimensional reconstruction of pelvic anatomical model,precise resection boundary of tumor,individual surgical template,individual prosthesis,and surgical simulation were precisely made by computer with CAD software.Based on the proposal of CAD,the bone tumor was resected accurately,and allograft ilium with internal fixation instrument or allogeneic ilium with personalized prosthetic replacement were used to reconstruct the bone defect after tumor was resected.Results The operation was successfully performed in 5 cases.The average operation time was 7.9 hours,and the average blood loss was 3 125 mL.Hemorrhage and cerebrospinal fluid leakage occurred in 1 case,respectively,and were cured after debridement.Five patients were followed up from 24 to 50 months（mean,34.5 months）.All patients began non-weight bearing walk with double crutches at 4-6 weeks after operation,and began walk at 3-6 months after operation.Local recurrence developed in 2 patients at 18 months after operation,and resection and radiotherapy were performed.According to International Society of Limb Salvage criteria for curative effectiveness of bone tumor limb salvage,the results were excellent in 2 and good in 3.Conclus

关 键 词：计算机辅助设计 骨盆肿瘤 个性化假体 同种异体髂骨 功能重建 

分 类 号：R738[医药卫生—肿瘤]