计算机辅助股骨粗隆部肿瘤精确切除和保髋重建的临床研究  

Computer-assisted personalized resection of femoral trochanteric tumor or tumor-like lesions and hip reconstruction

作　　者：丁焕文[1] 陈志源[1,2] 涂强[1] 沈健坚[1] 刘辉亮[1] 王虹[1] 滕强[1,2] 

机构地区：[1]广州军区广州总医院华侨楼骨科,510010 [2]广州中医药大学,510405

出　　处：《中华关节外科杂志（电子版）》2015年第1期13-17,共5页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：广东省自然科学基金(S2013010012015);广东省科技计划项目(2012A030400024);广东省教育部产学研结合项目(2009B090300454)

摘　　要：目的研究计算机辅助股骨粗隆部肿瘤或肿瘤样变精确切除和保髋重建的新方法,评价计算机辅助技术治疗股骨粗隆部肿瘤或肿瘤样变的价值。方法 2005年1月至2014年6月共收治10例股骨粗隆部肿瘤或类肿瘤样变患者,年龄为18~53岁,其中男7例,女3例,1例骨巨细胞瘤伴动脉瘤样骨囊肿,1例骨巨细胞瘤,1例恶性淋巴瘤,1例骨纤维组织细胞瘤,1例骨软骨瘤,5例骨纤维结构不良。术前均采用CT或MRI扫描获取肿瘤及肿瘤周围组织的二维图像数据,输入Mimics软件三维重建双下肢骨骼解剖模型及股骨粗隆部肿瘤模型,根据肿瘤性质借助Imageware软件三维匹配、分析确定肿瘤切除边界,术前用Imageware、UG-NX软件设计个性化手术辅助模板,并采用计算机仿真模拟股骨粗隆部肿瘤精确切除、重建过程。最后按术前预设方案精确实施股骨粗隆部肿瘤精确切除、异体骨＋内固定重建术。结果 10例均精确切除肿瘤或肿瘤样变,且保髋重建修复满意。7例病灶局限于粗隆部者采用大段异体骨、自体髂骨＋股骨近端解剖钢板固定,3例肿瘤累及股骨粗隆下采用异体骨、自体髂骨＋股骨重建钉固定,术后X线片显示骨缺损区域结构重建效果好,恢复了骨缺损区域解剖结构,均于术后3~6个月恢复行走功能。术后随访6个月~3年,1例恶性淋巴瘤复发并全身转移,余9例未见复发。结论计算机辅助技术可以在保留最大范围正常骨骼的情况下精确切除肿瘤和保髋重建股骨粗隆部骨缺损区域。计算机辅助技术使股骨粗隆部肿瘤切除手术更精确,疗效更佳。Objective To explore the new approach of computer-assisted personalized resection of femoral trochanteric tumor or tumor-like lesions and accurate hip reconstruction,and to investigate the value of computer-aided design in the treatment of femoral trochanteric tumor or tumor-like lesions.Methods Ten patients with femoral trochanteric tumor or tumor-like lesion were treated between January2005 and June 2014,and the clinical data were analysed. There were seven males and three females,aged from 18 to 53 years. The enrolled cases included one case of giant cell tumor with aneurysmal bone cyst,one case of giant cell tumor,one case of malignant lymphoma,one case of benign fibrous histiocytoma,one case of osteochondroma, and five cases of osteofibrous dysplasia. Computed tomography（ CT） and magnetic resonance imaging（ MRI） data were input into Mimics and Imageware software to develope threedimensional（ 3D） models of the tumor extent. The imaging data were used to create the templates for precise surgical resection and allograft modification by Imageware and UG-NX software. The surgical simulations were performed prior to the actual surgery. Based on the computer aided design proposal,the femoral trochanteric tumor or tumor-like lesions were removed accurately,and the allograft bones with matched shape were used to reconstruct the bone defect after the resection. Results The tumors of the 10 cases were removed accurately and the effect of bone defect repairing was satisfactory. Seven patients whose lesions located at the tuberosity underwent reconstruction with large allograft and autogenous iliac graft plus the proximal femoral anatomic plate fixation; three patients whose tumors involved the femoral subtrochanteric part underwent reconstruction with the allograft and autogenous iliac graft plus the reconstructive interlocking nail fixation. All the patients began walking three to six months after the operation. The postoperation X-ray films suggested the effect of bone defect reconstruction was good,and th

关 键 词：计算机辅助设计 骨肿瘤 股骨 外科手术 

分 类 号：R687.3[医药卫生—骨科学]