3D打印模型辅助骶骨脊索瘤整块切除  

The application of en-bloc resection of primary sacral chordoma based on 3-Dimensional printing technology

作　　者：孔金海[1] 钱明[1] 钟南哲 肖辉[2] 赵剑[1] 杨兴海[1] 魏海峰[1] 孙正望 严望军[1] 刘铁龙[1] 肖建如[1] 

机构地区：[1]第二军医大学附属长征医院骨肿瘤科,上海200003 [2]中国人民解放军474医院骨科,乌鲁木齐830013

出　　处：《中华骨科杂志》2017年第10期620-628,共9页Chinese Journal of Orthopaedics

摘　　要：目的探讨3D打印模型在骶骨脊索瘤整块切除中的可行性及临床效果。方法回顾性分析2013年1月至2014年12月共31例经后路或前后联合入路完整切除的骶骨脊索瘤患者的临床资料，男21例，女10例；年龄26-67岁，平均（49．2±12．5）岁。术前3D打印模型包括累及骶骨的肿瘤组织及周围血管、神经，并根据模型进行完整切除减压内固定重建。结果31例随访时间19-41个月，平均（29±6．8）个月。31例均行整块切除肿瘤组织，其中单纯后路26例，前后路联合5例；手术平均时间为（275．0±58．1）min，平均失血量（3250．0±1304．4）ml。术前视觉模拟评分法（visual analogue scale，VAS）评分为3-9分，平均（5．6±1．9）分；术后（2．0±1．5）分，较术前明显缓解。术前神经功能美国脊髓损伤协会（Americat Spinal Iniury Association，ASIA）损伤分级C级13例，D级11例，E级7例；术后C级5例，D级6例，E级20例，较术前明显好转。术后3个月随访时，临床骨骼肌肉肿瘤协会（Musculoskeletal Tumor Society，MSTS）93功能评分6-29分（20．0％-96．7％），平均（19．8±5．8）分，其中优8例，良14例，可5例，差4例。2例因为肿瘤包绕单侧S,2神经给予牺牲神经根的肿瘤完整切除后，大小便功能障碍，余29例患者术后疼痛症状消失，术前伴有会阴部感觉障碍的有明显改善；术中2例脑脊液漏患者，行腰大池引流术后顺利拔管。1例坠积性肺炎经抗炎后治愈；1例术前有膀胱造瘘的糖尿病患者，术后泌尿系感染，经积极有效膀胱冲洗，全身抗炎，局部对症治疗后好转；1例皮肤因术前血管栓塞后缺血坏死，术后半个月行皮瓣转位，3个月后恢复。1例术后15个月m现局部肿瘤复发，给予相应部位肿瘤切除。结论术前3D打印技术有助于安全而有效地辅助术中完整沿边界切除骶骨脊索瘤，减少毗邻的大动、静脉及周围�Objeetive To investigate the safety and feasibility of en-bloc resection of a primary sacral chordnma based on a 3-dimensional printing model. Methods 31 patients with primary sacral chordoma underwent en-bloc resection via a onestage posterior approach or combined anterior and posterior approaches in our ontology department from January 2013 to December 2014. They eomprised 21 males and 10 females of mean age （49.2±12.5） years （range, 26-67 years）. Preoperative 3-D printing models were created by 3D printing technology, it included tumor tissue, the around vascular and nerves involved in sacral chordo- ma. The sacral chordomas were en-bloc resection with decompression and internal fixation. Results With the mean （29.0±6.8） months follow-up （range from 19 to 41）, all patients underwent en bloc excision via 26 eases with posterior approaeh, 5 cases combined posterior and anterior approaches in one stage. The mean operative time and estimated blood loss were （275.0±58.1） rain and （3 250.0±1 304.4） ml, respectively. The visual analogue scale （VAS） score was （5.6±1.9） in average （range from 3 to 9） at pre- operation, and （2.0±1.5） at post-operation, which was significantly lower than that of preoperation, and the pain was relief obvious- ly. There were 13 cases in grade C, 11 cases in grade D, 7 eases in grade E of American Spinal Injury Association （ASIA） grade neurological fimction before surgery, compared with the pre-operation, there were 5 cases in grade C, 6 cases in grade D, 20 cases in grade E of post-operation,which was significantly improved. MSTS （Musculoskeletal Tumor Society） 93 score was 6-29 points （20.0%-96.7%） at the follow-up 3 months after surgery, with the average of （19.8 ± 5.8） points, which excellent in 8 cases, good in 14 cases, general in 5 cases, poor in 4 cases. Two cases of dysporia for the reasons of resecting on one side of the S~.2 nerve roots in- volved by the saeral chordoma, after sacrificing the nerve root of comple

关 键 词：骶骨 脊索瘤 外科手术 计算机辅助 

分 类 号：R738[医药卫生—肿瘤]