数字骨库辅助异体骨选配在骨肿瘤中的应用及长期疗效观察  

The Virtual Bone Bank System for Selecting Massivebone Allograft in Orthopaedic Oncology and Results of Long Time Follow-up

作　　者：杨迪 吴智钢 付军 范宏斌 李小康 郭征 Yang Di;Wu Zhigang;Fu Jun(Department of Orthopaedics,Xijing Hospital,Fourth Military Medical University,Xi'an710032,China;No.518 Hospital of the Chinese People's Liberation Army,Xi'an710043,China)

机构地区：[1]空军军医大学西京医院骨科,陕西西安710032 [2]中国人民解放军第518医院,西安710043

出　　处：《实用骨科杂志》2019年第5期423-427,共5页Journal of Practical Orthopaedics

基　　金：国家自然科学基金项目(81171773)

摘　　要：目的本研究旨在探讨一种数字骨库系统的建立及在异体骨选配中的应用,并观察其远期治疗效果。方法异体骨经过CT扫描后存储为医学数字影像交互格式。然后依据CT密度值进行图像分割和三维模型重建,建立数字骨库系统。基于体积参数将异体骨在数字骨库中进行登记。异体骨的选配及应用分别以1例骨盆尤文肉瘤和1例胫骨远端骨肉瘤患者的治疗过程为例进行阐述。采用计算机导航辅助手术,实现术中的精确切除与重建。结果通过数字骨库和计算机导航辅助,异体骨与骨肿瘤切除后骨缺损之间实现精确匹配。术后5年随访,肿瘤无局部复发或远处转移,功能效果满意。结论数字骨库系统有助于异体骨选配和骨肿瘤切除重建,可提高骨肿瘤保肢手术的疗效。Objective To describe the establishment of a visual bone bank system and workflow of allograft selection,and observe long-term follow-up results of patients after allograft implantation. Methods Allografts were CT scanned and stored in Digital Imaging and Communications in Medicine (DICOM) files.Then,image segmentation was conducted and 3D model reconstructed to establish a virtual bone bank system.Based on the volume registration method,allografts were registrated in the bone bank system.The selection and matching of the allograft were shown by treatments to a patient with Ewing's sarcoma in pelvis and a patient with osteosarcoma in distal tibia.With a careful matching process,the surgery was conducted with the help of Computer-assisted Orthopaedic Surgery (CAOS) navigation system. Results By combining the virtual bone bank and CAOS,matching accuracy was satifactory.Within 5 years follow-up,the two patients were alive without evidence of disease and with a good limb fuction. Conclusion The virtual bone bank system is helpful for allograft selection,matching,tumour excision and bone reconstruction,thus improving the safety and effectiveness of limb-salvage surgery for orthopaedic oncology.

关 键 词：异体骨 数字骨库 骨肿瘤 计算机导航辅助 

分 类 号：R738.1[医药卫生—肿瘤]