数字化骨库的建立及在骨肿瘤切除异体骨关节个体化重建中的应用  

The construction of digital bone bank and its application in bone tumor resection with allogenic osteoarticular individual reconstruction

作　　者：吴智钢[1] 付军[1] 郭征[1] 王臻[1] 范宏斌[1] 栗向东[1] 李靖[1] 裴延军[1] 裴国献[1] 李丹[1] 

机构地区：[1]西安第四军医大学西京骨科医院骨肿瘤科,710032

出　　处：《中华关节外科杂志（电子版）》2012年第3期60-63,共4页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的探讨数字化骨库建立的可行性,评价异体骨数字化对于导航下骨肿瘤切除异体骨重建的影响。方法采用CT扫描的方法,对骨库深低温冷冻保存的同种异体骨段进行扫描,通过三维重建建立数字化分析系统(数字化骨库)。利用数字化骨库,选择最佳匹配的骨关节重建材料,数据导入计算机导航系统,标定骨肿瘤切除和异体骨段的截骨范围,依据术前设计在导航下实施、监测。2009年11月至2011年11月,采用数字化骨库和导航辅助切除重建技术对6例关节周围恶性骨肿瘤进行治疗,患者平均年龄(27.2±9.1)岁,其中骨肉瘤3例,软骨肉瘤2例,尤文氏肉瘤1例;Enneking分期:ⅡA期2例,ⅡB期4例,术后评价肿瘤学结果和功能恢复情况。结果与常规异体植骨材料术前准备操作相比,数字化骨库建立后,大大缩短了异体骨关节材料的选配时间,同时明显地提高了选配的精确性。计算机导航辅助下进行肿瘤切除、异体骨关节切割以及关节力线监控,术中解剖注册点与CT三维虚拟影像匹配满意,注册误差(0.42±0.17)mm。术后影像显示肿瘤整块切除范围和异体骨关节截骨区域与术前计划完全一致,关节重建稳定,无肢体不等长和关节畸形。随访(19.3±7.1)个月,未见局部复发和远隔转移,无明显免疫排异反应,异体骨与宿主骨平均愈合时间(5.2±0.8)个月,无内固定松动、断裂和关节塌陷。MSTS93平均功能评分(26.2±4.1)分。结论数字化骨库的建立为术前选配同种异体骨材料提供了精细可靠的信息,结合计算机辅助导航,可以实现骨肿瘤切除异体骨关节重建的个性化设计要求,进一步提高保肢手术的安全性和效果。Objective To investigate the feasibility of a digital bone bank, and to evaluate the precision and effectiveness of accurate bone tumor resection mid allogenic bone graft reconstruction wilh computer-assisted navigation. Methods allogenie joints with profound hypothermia cryopreservation were sectionally scanned by CT in the FMMU Xijing hospital. The three-dimensional reconstructed images were saved and marked in the digital analytical system to establish digital bone bank. The three-dimensional reconstructed CT image data of bone tumor before surgery were compared with the allogenic osteoarticular data in the digital bone bank to select the optimal matched bone remodeling segments, and all the DICOM data were imported into the navigation system to accurately scale boundaries of tumor resection and allogenic osteoartieular cutting. During the surgery based on the preoperative design, the tumor was resected and the allogenic bone was cut with the navigation guidance to get allogenic bone structural reconstruction, which was validated by navigational system. From Jan 2009 to Jan 2011, the operative treatment assisted by digital bone bank and tumor resection with bone reconstruction by computer navigation technique was performed in six patients with malignant tumors. The average of age patient was （27. 2 ± 9. 1 ） years. The types of malignant tumor were osteosarcoma （three cases ）, chondrosarcoma （two cases ） and Ewing sarcoma （one case）. According to Enneking＇ s staging classification, there were two cases in stage l/A, and four cases in stage 1/ B. The local recurrence of tumor and functional results were followed up postoperatively. Results The establishment of the digital bone bank obviously shortened the time of selection for allogenic osteoarticular material before surgery and improved the accuracy of selection, compared to routine preparation of allogenic bone graft. Tumor resection and allogenic osteoartieular excision were performed with the assist of computer navigation. The dissection r

关 键 词：骨库 骨肿瘤 同种 骨移植 计算机辅助 

分 类 号：R738[医药卫生—肿瘤]