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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。
Objective To explore a new method of personalized resection and accurate reconstruction of computer-assisted malignant bone tumors and to evaluate the value of computer-assisted technique in the surgical treatment of malignant bone tumors. Methods From January 2007 to July 2010, 13 patients with malignant bone tumors were treated. Including 7 males and 6 females, aged 19 to 46 years. Enneking stage Ⅱ A in 8 cases, Ⅱ B in 5 cases. All patients underwent thin-section CT scan to obtain the two-dimensional data of the lesion, reconstruct the three-dimensional anatomical model, and accurately design the tumor resection scope, personalized surgical template and personalized bone prosthesis by computer aided design (CAD) , Simulating bone defect repair and reconstruction process. Tumor tissue was accurately resected according to the CAD program in the surgery, and allograft or allogeneic bone matched with personalized shape artificial bone replacement was used to reconstruct the left bone defect after resection of the bone tumor. During follow-up, functional evaluation of follow-up patients was performed using the limb salvage scoring system of the Musculoskeletal Tumor Society (MSTS). Results All 13 patients were followed up for 10 ~ 52 months with an average of 24.8 months. The early postoperative radiographs showed that the reconstruction of bone defect area was effective and the anatomic structure of bone defect area recovered. All patients survived, the last follow-up MSTS score was 17 to 27, with an average of 23.5 points, of which 7 cases were excellent, 4 good and 2 fair. Allogeneic bone infection occurred in 2 cases, one case had allograft nonunion, one case had plate fracture and two cases had allograft bone resorption. One case of acetabulum tumor local recurrence 18 months after surgery, resection of the tumor treatment. Conclusions The computer-aided technique is used in the surgical treatment of bone malignancies, which can correctly design the tumor resection boundary, accurately remove the tumor and accurately reconstruct the bone-joint structure in the diseased area so as to elevate the surgical treatment of the bone tumor to the height of personalized surgery .