计算机导航辅助下切除四肢干骺端恶性肿瘤保留自体关节的安全性及长期随访疗效评估  

The safety and long-term follow-up efficacy evaluation of autologous joints in resection of metaphysis malignant tumors of extremities assisted by computer navigation

作　　者：陈国景 李明辉 王凤伟 王臻 肖鑫 鲁亚杰 罗卓荆 李靖 Chen Guojing;Li Minghui;Wang Fengwei;Wang Zhen;Xiao Xin;Lu Yajie;Luo Zhuojing;Li Jing(Department of Orthopedic,Xijing Hospital Affiliated to the Air Force Military Medical University,Xi'an Shaanxi,710032,China)

机构地区：[1]空军军医大学西京医院骨科,陕西西安710032

出　　处：《生物骨科材料与临床研究》2022年第2期20-25,共6页Orthopaedic Biomechanics Materials and Clinical Study

摘　　要：目的 探讨计算机导航辅助下切除四肢干骺端恶性肿瘤保留自体关节的安全性及长期随访疗效。方法 选择2007年1月至2011年9月10例四肢关节干骺端ⅡB期恶性肿瘤患者,其中7例骨肉瘤,3例尤文肉瘤。术前薄层CT扫描数据和MRI数据输入计算机导航系统进行图像融合,术中用导航探头经过导航跟踪器将手术部位和导航计算机建立联系,然后用导航探头在固定的解剖定位点或术前制作的人工标记点进行计算机注册,再在骨暴露表面散在选择50个点注册增加图像和手术部位配准的准确性,验证若匹配误差小于1 mm则可用于术中导航。然后在导航指导下精准截骨切除肿瘤,腓骨瓣复合异体骨重建肿瘤切除后的骨缺损,术后定期随访,评估保留关节功能、有无肿瘤局部复发及相关并发症等。结果 术中计算机导航匹配误差平均为0.41 mm,导航下截骨线与肿瘤边缘之间的平均距离为9.9 mm,术后平均随访140个月,除1例肿瘤肺转移死亡外,其余所有患者均无瘤存活,所有患者均无局部肿瘤复发,肢体MSTS评分平均为27.8分。结论 导航辅助下可做到肿瘤精确切除,使关节结构保留最大化的同时保证肿瘤不复发,而保留的自体关节使得患者可以长期使用。Objective To investigate the safety and long-term follow-up efficacy of autologous joints after resection of metaphysis malignant tumors of extremities assisted by computer navigation. Methods Ten cases of stage ⅡB malignant tumors around the joints of the limbs from January 2007 to September 2011 were selected, including 7 cases of osteosarcoma and 3 cases of Ewing sarcoma. The preoperative thin-slice CT scan data and MRI data were input into the computer navigation system for image fusion. During the operation, the navigation probe was used to establish the connection between the surgical site and the navigation computer through the navigation tracker. The artificial marker points were registered by computer, and then 50 points were scattered and registered on the exposed surface of the bone to increase the registration accuracy of the image and the surgical site. It was verified that if the matching error was less than 1mm, it could be used for intraoperative navigation. Then, under the guidance of navigation, precise osteotomy was performed to remove the tumor, and the fibular flap combined with allogeneic bone was used to reconstruct the bone defect after tumor resection. Regular follow-up after surgery was performed to evaluate the preservation of joint function, and whether there was local tumor recurrence and related complications. Results The average error of intraoperative computer navigation matching was 0.41 mm, and the average distance between the osteotomy line and the tumor edge under navigation was 9.9 mm. The average postoperative follow-up was 140 months. Except for 1 patient who died of lung metastasis, all the other patients survived without tumor. All patients had no local tumor recurrence, and the average limb MSTS score was 27.8 points. Conclusion With the aid of navigation, accurate tumor resection can be achieved, which maximizes the preservation of joint structure while ensuring that the tumor does not recur, and thus allows the patient to use it for a long time.

关 键 词：计算机导航 干骺端 恶性肿瘤 自体关节 

分 类 号：R738.1[医药卫生—肿瘤]