计算机导航辅助骨盆软骨肉瘤切除术  

Computer navigation-assisted surgical techniques in the surgical resection of pelvic chondrosarcomas

作　　者：张清[1] 徐立辉[1] 赵海涛[1] 鱼锋[1] 牛晓辉[1] Zhang Qing;Xu Lihui;Zhao Haitao;Yu Feng;Niu Xiaohui(Orthopaedics Oncology of Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院骨肿瘤科,100035

出　　处：《中华骨科杂志》2020年第16期1070-1080,共11页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(61172125)。

摘　　要：目的探讨计算机导航辅助外科技术应用于骨盆软骨肉瘤精准切除的临床意义。方法回顾性分析2007年12月至2018年12月收治的采用计算机导航辅助外科技术手术的骨盆软骨肉瘤患者54例,男27例,女27例;年龄(34.00±1.41)岁(范围23~72岁)。47例为原发骨肿瘤,7例为复发骨肿瘤;肿瘤位于髂骨(Ⅰ区)15例,主要侵及髋臼(Ⅱ区)35例,耻骨(Ⅲ区)1例,侵及骶髂关节(Ⅳ区)3例。行穿刺活检45例(83.3%),切开活检4例(7.4%),5例未取活检,其中2例为多发骨软骨瘤恶变、2例为骨盆软骨肉瘤复发、1例经影像学检查诊断骨盆恶性肿瘤。病理分级:Ⅰ级36例,Ⅱ级15例,Ⅲ级3例。计算机导航引导下按术前设计完成肿瘤切除手术,其中保肢术49例(90.7%)、截肢术5例(9.3%)。采用切除肿瘤标本大体外观和肿瘤最大径剖面检查评估肿瘤外科切除边界。分析术前肿瘤状况、性别、肿瘤分型、活检方式、肿瘤位置、截肢或保肢、不同外科切除边界患者复发率的差异。结果切除边界为广泛切除39例,边缘切除13例,囊内切除2例。52例(96.3%)按术前计划的外科切除边界完成手术,2例未完成。54例均获得随访,随访时间(84.00±93.34)个月(范围12~150个月)。存活45例,术后发生肺转移而死亡9例。局部骨与软组织复发8例(14.8%,8/54),其中保肢者复发7例(14.3%,7/49)、截肢者复发1例(20.0%,1/5)。不同外科切除边界患者局部复发率的差异有统计学意义(χ2=17.022,P=0.001);边缘切除复发的风险是广泛切除的8.222倍[95%CI(1.297,52.140)]。按美国肌肉骨骼系统肿瘤协会(Musculoskeletal Tumor Society,MSTS)93肢体功能评价体系进行评估,术后肢体功能恢复率为90.00%±4.71%(范围60.00%~100%)。术后发生并发症13例(24.1%),其中感染7例(13.0%)、术区及下肢深静脉血栓2例(3.7%)、伤口皮缘坏死延迟愈合4例(7.4%)。保肢术49例中,复发后截肢2例,5例患者肿瘤巨大侵及血管、神经而选择了Objective To explore the clinical effects of computer navigation-assisted surgery in the precise resection of pelvic chondrosarcoma.Methods A retrospective analysis of 54 patients who had computer-assisted surgery from Dec 2007 to Dec 2018,including 27 males and 27 females,was conducted.The average age was 34.00±1.41 years(range 23-72 years).There were 47 cases with primary tumors and 7 with recurrence cases.The tumors in 15 cases located in the ilium(region I),35 in the acetabulum(region II),1 in the pubic(region III),and 3 in the sacroiliac joint(region IV).A total of 45 cases(83.3%)underwent needle biopsy,and 4 cases(7.4%)had incision biopsy.Among 5 cases who did not have biopsy,two of them was diagnosed of malignant change of multiple osteochondromas,two cases were diagnosed of recurrent pelvic chondrosarcoma and one with pelvic malignant tumor by imaging examinations.Pathological grade was presented as following,36 cases in grade I,15 in grade II,and 3 in grade III.All operations were performed on the bases of preoperative design with computer navigation-assisted surgical technology.A total of 49 cases(90.7%)had limb salvage operations and 5 cases had amputations.The surgical margins were confirmed by gross appearance and the maximum diameter profile of the tumor.Univariate analysis was performed to compare recurrence rate of different preoperative tumor status,gender,tumor stage,biopsy method,tumor location,operation method and surgical margins.Results There were 39 cases underwent extensive resection,13 cases with marginal resection and 2 cases with intracapsular resection.In 52 cases(96.3%),the surgery was performed according to the preoperative plan of surgical resection margin.However,two cases(3.7%)was not performed based on the preoperative plan.All patients were followed-up for 84.00±93.34 months(range 12-150 months).During the follow-up,a total of 45 cases(83.3%)survived and 9 cases died from lung metastasis.Eight cases(14.8%,8/54)had local recurrence of whom 7(14.3%)were limb salvage cases and 1(

关 键 词：软骨肉瘤 骨盆 外科手术 计算机辅助 

分 类 号：R738.3[医药卫生—肿瘤]