O-Arm导航在骨盆肿瘤切除与重建术中的应用  

Application of O-Arm navigation in pelvic tumor resection and reconstruction

作　　者：孙梦熊[1] 左冬青 马小军[1] 沈嘉康[1] 汪红胜 王崇任 昝鹏飞 华莹奇[1] 蔡郑东[1] 孙伟[1] SUN Meng-xiong;ZUO Dong-qing;MA Xiao-jun;SHEN Jia-kang;WANG Hong-sheng;WANG Chong-ren;ZAN Peng-fei;HUA Ying-qi;CAI Zheng-dong;SUN Wei(Department of Orthopedics,Shanghai General Hospital,Shanghai,200080,China)

机构地区：[1]上海市第一人民医院骨肿瘤科,200080

出　　处：《中国骨与关节杂志》2022年第8期567-573,共7页Chinese Journal of Bone and Joint

摘　　要：目的 O-Arm导航在6例骨盆肿瘤切除术中应用的临床结果。方法 2021年3月至2021年12月,共有6例骨盆肿瘤患者接受O-Arm导航下骨盆肿瘤切除术,男3例,女3例,年龄21~76岁,平均51.5岁;病理类型骨肉瘤2例,去分化软骨肉瘤1例,间叶性软骨肉瘤1例,恶性孤立性纤维瘤1例,上皮样血管肉瘤1例。Ennecking分期ⅡA期1例、ⅡB期5例。所有患者均在O-Arm导航下进行保肢手术并根据导航验证术中安放假体髋臼位置及旋转中心位置,其中保留部分髋臼自体股骨头移植全髋关节置换1例,半骨盆置换5例。术后评价患者肿瘤学预后及功能学预后。结果 6例均顺利接受了手术治疗,手术时间3.5~5.0h,平均4.1h;术中均未发生重要神经、血管、脏器损伤,术中失血量1000~3000ml,平均1750ml。肿瘤累及范围:Ⅱ区1例,Ⅰ区+Ⅱ区3例,Ⅰ区+Ⅱ区+Ⅲ区1例,Ⅰ区+Ⅱ区+部分Ⅳ区1例。术中导航结合术前定制导板截骨3例,导航探针引导下截骨3例,所有肿瘤均获得完整切除并经术后大体及镜下病理明确切缘阴性。本组6例获平均4.1个月随访。肿瘤无局部复发,早期伤口皮缘坏死1例,经清创术后伤口愈合。无深部感染。无深静脉血栓形成。无髋关节脱位。术后1个月MSTS-93下肢功能评分平均25.7分(23~28分),其中优4例,良2例。末次随访无肢体短缩、假体松动及断裂。结论 O-Arm导航在骨盆肿瘤切除术中实时扫描获取手术野精准导航地图,在复杂的骨盆解剖结构中精准实行肿瘤切除并恢复髋关节旋转中心,具有一定的推广应用价值。Objective To explore the application of O-Arm navigation in pelvic tumor resection.Methods From March 2021 to December 2021,6 patients with pelvic tumor underwent O-Arm guided pelvic tumor resection,including 3 males and 3 females.The average age was 51.5 years (range:21-76 years).There were 2 cases of pathological osteosarcoma,1 dedifferentiated chondrosarcoma,1 mesenchymal chondrosarcoma,1 malignant solitary fibroma and 1 epithelioid angiosarcoma.Ennecking stage ⅡA in 1 case and stage ⅡB in 5 cases.All patients underwent limb salvage surgery under O-Arm navigation,and the acetabular position and rotation center of prosthesis were verified according to the navigation,including partial acetabular autologous femoral head transplantation and total hip replacement in 1 case,and hemipelvic replacement in 5 cases.The oncological prognosis and functional prognosis were evaluated after operation.Results All 6 patients underwent surgery successfully.The average operation time was 4.1 h (range:3.5-5.0 h).No important nerve,blood vessel or organ injury occurred during the operation.The average blood loss was 1750 ml (range:1000-3000 ml).Range of tumor involvement:1 case in zone Ⅱ,3 cases in zone Ⅰ + zone Ⅱ,1 case in zone Ⅰ + zone Ⅱ + zone Ⅲ,1 case in zone Ⅰ + zone Ⅱ + partial zone Ⅳ.Intraoperative navigation combined with preoperative customized guide plate osteotomy was applied in 3 cases and navigation probe guided osteotomy in 3 cases.All tumors were completely removed and confirmed by postoperative gross and microscopic pathology.All patients were followed up,with an average follow-up of 4.1 months (range:1-9 months).There was no local recurrence of the tumor,and 1 case with early wound skin edge necrosis healed after debridement.No deep infection,deep vein thrombosis or hip dislocation was observed.One month after operation,the mean score of MSTS-93 lower limb function was 25.7 (range:23-28).There were 4 excellent cases and 2 good cases.At the last follow-up,there was no limb shortening,prosthesi

关 键 词：骨盆 骨肿瘤 O-Arm导航 

分 类 号：R738.1[医药卫生—肿瘤]