计算机导航辅助下保留关节治疗肢体恶性骨肿瘤  

Computer navigation used in precise resection and joint-sparing surgery for limbs with malignant bone tumor

作　　者：张清[1] 牛晓辉[1] 王涛[1] 鱼锋[1] 李远[1] 赵海涛[1] 徐立辉[1] 

机构地区：[1]大学医学部第四临床教学医院,北京积水潭医院骨肿瘤科,北京100035

出　　处：《中华创伤骨科杂志》2011年第12期1148-1151,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨应用计算机导航辅助下保留关节治疗肢体恶性骨肿瘤的意义。方法2008年9月至2011年3月，行保留关节人工假体和大段异体骨置换术治疗12例股骨远段、胫骨近段和胫骨远段恶性肿瘤患者，其中男7例，女5例；年龄12-59岁，平均26．7岁；病变位于股骨远段干骺端8例，胫骨近段干骺端3例，胫骨远段干骺端1例；骨肉瘤7例，软骨肉瘤3例，血管内皮瘤1例，梭形细胞肉瘤1例。术前采用增强CT和MRI在计算机导航工作站上设计术前方案，明确病灶侵犯的髓内范围和骨外范围，设计截除瘤骨的范围并标记，术中计算机导航指引下，注册定位，按术前设计截断瘤骨，保留关节及韧带组织，装配制人工假体8例和大段异体骨置换4例。结果12例患者全部按术前计划完成手术，术后肿瘤标本经病理验证达到广泛切除。所有患者随访7-37个月，平均21个月。按肌肉骨与软组织肿瘤协会（MSTS）患肢功能评价体系评分，术后肢体功能恢复92％-96％，平均94％。术后无伤口及关节感染发生，无局部复发和远隔转移发生。结论计算机导航技术可以在术中精确实现术前设计的肿瘤外科切除边界，避免盲目扩大肿瘤切除范围和损失重要的骨骼关节结构，从而为患肢关节结构重建创造条件，提高肢体功能恢复水平。Objective To report our experience of using image-guided computer navigation for precise reseclion and joint-sparing reconstruction in musculoskeletal tumor surgery. Methods Between September 2008 and March 2011, surgical resections and joint-sparing reconstructions, with assistance of image-guided computer navigation, were performed for 12 patients with malignant bone tumors. There were 5 females and 7 males, with an average age of 26.7 years （from 12 to 59 years）. The tumor was located at distal femur diaphysis in 8 cases, at proximal tibia in 3 and at distal tibia in one. By pathological diagnosis, there were 7 osteusarcomas, 3 chondrosarcunms, one hemendothelioma and one spindal cell sarcoma. Three-dimensional models of bone tumor were reconstructed for each patient on the basis of preoperative CT anti MRI data. Using the models, we made preoperative plan for each patient with the navigation system software to locate tumor surgical margin and design resection and reconstruction with a custnm-made joint-sparing prosthesis for femur tumors and an allograft tor tibia tumors, lntraoperatively, we carried out the process of registration and matching the operative anatomy to the virtual image generated by the navigation system software. Then we performed surgical processes according to the preoperative plan. Results The tumor resections and joint-sparing reconstructions with custom-nmde prostheses and allografts were completed for all cases as precisely as preoperative plan designed. All the resection speeimens showed a safe and clear margin. The average distance from the resection margin to the joint were 35 mm （from 12 mm to 80 mm）. All the patients were followed tbr an average of 21 months （from 7 to 37 months）. By lhe Musculoskeletal Tumor Society （MSTS） evaluation system, the patients achieved 92 % to 96% of limb functional recnvery （average, 94% ） . No wound or joint infection, no local relapse or remote metastasis occurred. Conclusion The image-guided computer navigation system greatly fa

关 键 词：骨肿瘤 外科手术 计算机辅助 假体植入 

分 类 号：TP399-C8[自动化与计算机技术—计算机应用技术] R738.1[自动化与计算机技术—计算机科学与技术]