计算机辅助恶性骨肿瘤个性化切除与精确重建

目的探讨计算机辅助恶性骨肿瘤个性化切除与精确重建的新方法,评价计算机辅助技术在恶性骨肿瘤手术治疗中的价值。方法 2007年1月～2010年7月共收治13例恶性骨肿瘤患者。其中男7例,女6例,年龄19～46岁。Enneking分期ⅡA期8例,ⅡB期5例。所有患者均采用薄层CT扫描获取病变部位的二维数据,重建三维解剖模型,运用计算机辅助设计（computer aided design,CAD）技术精确设计肿瘤切除范围、个性化辅助手术模板以及个性化骨修复体,模拟骨缺损修复重建过程。术中按照CAD方案精确切除肿瘤组织,采用外形匹配的异体骨或异体骨＋个性化人工关节置换重建骨肿瘤切除后遗留骨缺损。随访期间采用骨与软组织肿瘤学会（Musculoskeletal Tumor Society,MSTS）保肢评分系统对随访患者进行功能评价。结果 13例患者均获得随访,随访时间10～52个月,平均24.8个月。术后早期X线片显示骨缺损区域结构重建效果好,骨缺损区域解剖结构获得恢复。所有患者均存活,末次随访MSTS评分为17～27分,平均23.5分,其中优7例,良4例,可2例。2例发生异体骨感染,1例异体骨不愈合,1例钢板断裂,2例异体骨吸收。1例髋臼肿瘤术后18个月局部复发,行肿瘤再切除治疗。结论将计算机辅助技术用于骨恶性肿瘤的手术治疗,可以正确设计肿瘤切除边界、准确切除肿瘤并对病变区域的骨关节结构进行精确重建,从而将骨肿瘤手术治疗提升到个性化外科手术的高度。

Computer-assisted individual resection and precise reconstruction for malignant bone tumors

Objective To explore new approaches of computer-assisted individual resection and accurate reconstruction and to evaluate the value of computer aided techniques in the surgical treatment for malignant bone tumors.Methods Thirteen cases with bone malignant tumors were treated surgically from January 2007 to July 2010.There were 7 males and 6 females,aging from 19 to 46 years.According to the Enneking System for Staging Benign and Malignant Musculoskeletal Tumors,8 cases were in ⅡA and 5 cases in ⅡB.2D images of lesion area of all patients were acquired by thin-section CT scanning,3D reconstruction of anatomical model were accomplished,tumor resection extent,individual surgical template and prosthesis were designed precisely as well as repair and reconstruction for bone lesions were simulated by computer aided design（CAD） techniques.During the operation,tumor tissue was precisely resected according to the preoperative CAD plan.Replacement of contour-matched bone allograft or allograft ＋ customized individual prosthesis were applied to reconstruct bone defect after tumor resection.The Musculoskeletal Tumor Society（MSTS） score was used to evaluate the recovery of their corresponding functions during the follow-up.Results All patients were followed up from 10 to 52 months,with average 24.8 months.The postoperative X-ray showed that structural reconstruction of bone defect area achieved good effect and the normal anatomic structure had recovered.During the follow-up,13 cases were all survived.The MSTS score was 17-27 with an average of 23.5 at the last follow-up.There were excellent in 7 cases,good in 4 cases and fair in 2 patients.As for the complications,bone allograft infection occurred in 2 cases,non-union in 1 case,plate rupture in 1 case,bone allograft absorption in 2 cases.Tumor resection was performed 18 months after the first operation in one case because of local recurrence.Conclusions Computer aided surgery for malignant bone tumors can help to design the excisional boundary of the bone tumor accurately,resect the tumor exactly and reconstruct bone and joint structure precisely.As a result,the level of bone tumor surgical treatment can be enhanced to individual surgery with computer aided techniques.