计算机辅助下膝关节周围肿瘤的精确切除与重建  

Computer-assisted precise resection and reconstruction of the tumor around the knee

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

机构地区：[1]华南理工大学材料科学与工程学院,广州市510641 [2]广州军区广州总医院,510010

出　　处：《中国骨与关节杂志》2012年第1期60-67,共8页Chinese Journal of Bone and Joint

基　　金：国家自然科学基金(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：目的研究计算机辅助膝关节周围肿瘤的精确切除与重建的新方法,评价计算机辅助技术在膝关节周围骨肿瘤治疗中的价值。方法 2007年1月至2010年7月共收治6例膝关节周围肿瘤患者。其中男4例,女2例。年龄19～40岁。股骨远端骨肉瘤3例,胫骨近端骨肉瘤1例,胫骨近端软骨肉瘤2例。Enneking分期ⅡA期2例,ⅡB期4例。所有患者术前均采用薄层CT和MRI扫描获取骨关节和肿瘤部位的二维图像数据,计算机三维重建建立骨关节和肿瘤浸润区域解剖模型,借助逆向工程和CAD软件三维测量确定肿瘤切除范围,CAD设计个性化辅助手术模板及个性化的骨修复体,计算机辅助模拟膝关节周围肿瘤切除和重建过程。术中按照计算机辅助模拟的手术方案,完整切除肿瘤组织,其中4例患者采用"外形匹配的异体骨+定制个性化膝关节假体"、2例患者采用"外形匹配的异体骨+钢板"重建骨肿瘤切除后遗留骨缺损。随访期间采用骨与软组织肿瘤学会(musculoskeletal tumor society,MSTS)保肢评分系统对随访患者进行功能评价。结果所有患者随访10-53个月,平均30.5个月。随访期间未发现膝关节假体、钢板的断裂和松动,2例患者出现异体骨吸收,1例患者异体骨感染、行局部清创术治疗,无肿瘤复发和转移。末次随访MSTS评分为18～27分,平均23.4分,其中优4例,良2例。结论借助于计算机辅助技术,可以实现膝关节周围肿瘤的精确切除和功能重建;异体骨复合金属假体或内固定物重建骨缺损具有良好的临床疗效和应用价值。Objective To investigate a new method of precise resection and reconstruction of the tumor around the knee using computer aided design technology and to assess the value of computer aided design technology in the treatment of the bone tumor around the knee. Methods 6 cases of tumors around the knee were treated surgically from January 2007 to July 2010. There were 4 males and 2 females, aging from 19 to 40 years old. 3 cases were of distal femoral osteosarcoma, 1 case was of proximal tibial osteosarcoma and 2 cases were of proximal tibial chondrosarcoma. According to the Enneking System, 2 cases were in II A and 4 cases were in II B. All the patients were checked with thin-section CT and MRI scanning to achieve two-dimensional image data in bone and joint tumor region. The anatomical models of tumor invasion area of bone and joint were done by the three-dimensional reconstruction of the computer. The extent of tumor resection was determined by reverse engineering and three- dimensional measurement of CAD software. Personalized auxiliary surgical template and personalized bone restoration were designed by CAD software. The procedure of tumor resection and reconstruction around the knee was simulated with the aid of computer. During the operation the tumors were completely resected according to the surgery program simulated with the aid of computer. To reconstruct the remaining bone defect after bone tumor resection, ＂shape- matching allograft bone and customized personalized knee prosthesis＂ were applied in 4 patients and ＂shape-matching allograft bone and steel plate＂ were applied in 2 patients. The patients＇ corresponding functions were evaluated according to the limb-salvage scoring system of Musculoskeletal Tumor Society （MSTS）. during the follow-up. Results All the patients were followed up for an average of 30.5 months （range; 10-53 months）. No fracture or loosening of the knee prosthesis and steel plate occurred in the follow-up. Allograft bone absorption occurred in 2 cases, and allograft

关 键 词：计算机辅助设计 膝关节 恶性骨肿瘤 个性化骨修复体 个性化假体 内固定 

分 类 号：R687.3[医药卫生—骨科学]