计算机导航辅助下保膝重建干骺段缺损治疗股骨远端骨肉瘤六例报告  

Clinical application of computer navigation-assisted knee sparing reconstruction strategy in the treatment of osteosarcoma of distal femur

作　　者：沈嘉康 蔡郑东 汪红胜 昝鹏飞 孙梦熊 左冬青 孙伟[1] SHEN Jia-kang;CAI Zheng-dong;WANG Hong-sheng;ZAN Peng-fei;SUN Meng-xiong;ZUO Dong-qing;SUN Wei(Department of Orthopaedic Oncology,The First People’s Hospital affiliated to Shanghai Jiaotong University School of Medicine,Shanghai,200080,China)

机构地区：[1]上海交通大学医学院附属第一人民医院骨肿瘤科,200080

出　　处：《中国骨与关节杂志》2023年第3期176-180,共5页Chinese Journal of Bone and Joint

摘　　要：目的报告股骨远端骨肉瘤患者,在计算机导航辅助下,行保膝重建治疗的近期临床结果。方法收集了2014年1月至2015年12月,本中心收治的6例原发于股骨远端骨肉瘤患者,男5例,女1例。中位年龄12岁。入院后行胸部CT、全身骨扫描、局部X线片、CT和MRI。予以术前MAP新辅助化疗4个疗程后全麻下行肿瘤切除并假体重建术。术中使用O型臂机采集即时影像数据,结合导航系统定位截骨。使用订制假体重建骨缺损。术后随访统计肿瘤切除边界、膝关节活动度ROM、步态、MSTS评分。结果所有患者均获随访,中位随访期29个月。所有病例均为R0切缘。MSTS评分(27±1.3)分。术后有1例肺部转移,1例假体无菌性松动,2例伤口脂肪液化。结论计算机导航下截骨,能更准确地执行术前计划,获得更满意的切除边界。Objective To report the short-term clinical outcomes of computer-navigation assisted knee sparing reconstruction in patients with osteosarcoma of the distal femur.Methods Six patients(5 males and 1 female)with primary osteosarcoma of the distal femur who were admitted to our center from January 2014 to December 2015were collected.The median age was 12 years old.After admission,thoracic CT,ECT,local X-ray CT Scan and MRI were performed.Preoperative MAP neoadjuvant chemotherapy was administered for 4 courses.Tumor resection and prosthesis reconstruction were performed under general anesthesia.Intra-operative image data were collected by the O-arm and resection was guided with the navigation system for all cases.Bone defects were constructed using custom-made endo-prosthesis.The resection boundary,ROM of knee joint,gait and MSTS score were collected during follow-up.Results All patients were followed up for a median of 29 months without loss of follow-up.All cases had an margin of R0.The average MSTS score was(27±1.3).There was 1 case of pulmonary metastasis,1 case of aseptic loosening of prosthesis,and 2 cases of fat liquefaction in wound.Conclusions Computer guided osteotomy will facilitate accurate operation with satisfactory resection boundary.

关 键 词：骨肉瘤 手术导航系统 保肢 骨骺 

分 类 号：R738.1[医药卫生—肿瘤]