Red blood cell polyamines in brain tumour patients

Red blood cell polyamine levels have been determined in patients with various histologically confirmed brain tumours. Increased spermine and spermidine levels were found in most patients with perifocal oedema demonstrated by CT; no correlation was found to other CT variables, nor to tumour localization. Polyamine levels increased during the clinical course coincident with tumour activity and decreased in response to surgery and radiotherapy. The response to chemotherapy involved a change in the relationship between spermine and spermidine levels. Our results underline the significance of regular polyamine level estimation during the management of patients with brain tumours.     

Nuclear magnetic resonance imaging of the region of the sella turcica

Summary Nuclear magnetic resonance (NMR) imaging is a versatile technique which has proved more sensitive in the detection of perisellar lesions than CT. A multiplanar facility, the demonstration of blood flow, and the lack of bone artefacts are its main advantages in this respect. Limitations are seen in its inability to identify small calcifications and to distinguish clearly perifocal oedema and tumour especially in malignant lesions. Relatively thick slices of 5–10 mm make the detection of microadenomas very difficult, mainly because of partial volume effects. T₁ and T₂ values alone are not sufficient to provide specific diagnosis. No reliable criteria have been determined yet, which would indicate the quality of pathological involvement of peritumorous structures by tumours of the sella region.At present NMR still plays a more complementary role to CT in the evaluation of this complex anatomical area. We are confident that with future technical refinements NMR will be able to replace ionizing radiation for the diagnostic imaging of the sella.     

Magnetic resonance tomography (MRT) of intracranial tumours: Initial experience with the use of the contrast medium gadolinium-DTPA

Summary The present study provides an introduction to the clinical diagnosis of intracranial lesions by means of magnetic resonance tomography (MRT). The demonstration of different tissue qualities (bone and bone marrow, cerebral cortex and medulla, ventricular system (CSF), blood, tumour and perifocal oedema) in the MR tomogram is explained. The principles of specific MRT contrast media and their clinical application in brain tumours are discussed in detail.     

Tumour-surgery within the central motor strip: Surgical results with the aid of electrical motor cortex stimulation

Summary Surgery of tumours within or close to the central motor area always carries the risk of a new or increased postoperative motor deficit. One reason may be the difficulty of localizing the sensorimotor region, when it is displaced or distorted by the tumour and the perifocal oedema. Recently anatomical data of the craniocerebral topography of the central sulcus^{6, 9, 15} became available. We safely used under general anaesthesia the intraoperative mapping of the motor cortex by direct cortical electrical stimulation. In 21 patients tumours adjacent to or within the motor area were microsurgically resected. As a result of intraoperative localization the surgical approach had to be modified in contrast to the preoperative localization of the lesion in 5 patients. No new or increased motor deficit occurred and in some cases the preoperative weakness was reduced remarkably.     

Diagnosis and treatment of progressive space-occupying radiation necrosis following stereotactic radiosurgery for brain metastasis: Value of proton magnetic resonance spectroscopy

Summary ¶Background. There have been some reports that radiation necrosis can be controlled conservatively. There are rare cases showing progressive space-occupying radiation necrosis (PSORN). It is very difficult to control PSORN by conservative treatment. The purpose of this study was to evaluate the early diagnosis of those cases and the timing of surgery for patients with PSORN. Method. We have experienced some cases where quality of life was improved by the removal of PSORN after stereotactic radiosurgery (SRS) for brain metastases. Therefore, we evaluated retrospectively the diagnosis and treatment of six cases of symptomatic PSORN at approximately 6–12 months after SRS for metastatic brain tumours. Findings. In all six cases, on Magnetic Resonance Imaging with Gd contrast material (Gd-MRI), PSORN was revealed as a ring-like enhanced mass with large perifocal oedema coupled with the appearance of neurological deficit. Proton Magnetic Resonance Spectroscopy (¹H-MRS) enabled us to differentiate PSORN from recurrence of metastases in all six cases. Single Photon Emission Computed Tomography with thallium-201 chloride (²⁰¹TlCl-SPECT) enabled us to do this in four cases of the six. In four cases of the six, lesionectomy of the ring-like enhanced mass (PSORN) was performed, and in two of these cases the removal was performed within 4 weeks from the time when conservative treatment became ineffective, and the neurological deficit and perifocal oedema was improved as was the quality of life. However, in the other two patients who were left for more than 16 weeks, the deficit was gradually progressive. The two patients who did not receive lesionectomy were treated by conservative means with steroids and/or heparin and warfarin and they had progressive neurological symptoms. Interpretation. Although, the number of patients is small in this study, and more data will be needed, it is recommended that lesionectomy is performed at an early stage, if possible, when conservative management has failed.     

Cerebral Gangliogliomas: Clinical Characteristics, CT and MRI

Summary  Eight patients with ganglioglioma who received surgical treatment at our institute between January 1989 and January 1997 were reviewed to determine their clinical, CT and MRI characteristics. Tumours were located in the temporal lobe (four patients), trigone of the lateral ventricle (two patients), basal ganglia (one patient) and fronto-temporal lobe (one patient). On imaging, two types of tumours were seen, a solid mass in 5 patients (62.5%) and a cystic mass in three patients (37.5%). Six complete tumours (75%) and all of the solid components of the cystic tumours were enhanced by contrast medium. Seven tumours (88%) had no peripheral oedema. On CT, the tumours being studied appeared as iso-(62.5%) or low density (37.5%) intra-axial tumours. Four tumours (50%) contained calcification. On MRI, the tumours appeared as well-circumscribed, iso- (62.5%) or low intensity (37.5%) intra-axial tumours on T1 weighted images, and as high (75%) on T2 weighted images. Three underwent total resection, 2 subtotal resection and 3 partial resection. No patients had have any further treatment such as radiation therapy or chemotherapy. Postoperative sudies were conducted on all patients with an average follow-up period 56 months (range 4–147 months) after surgery. There was no evidence of recurrence of tumours or of growth of residual tumours. We observed gangliogliomas which were located in unusual regions such as the trigone in two of the patients. To our knowledge, our series is the first report to describe trigonal gangliogliomas. We conclude, therefore, that ganglioglioma should be included as a possibility in the differential diagnosis of intracranial masses, even when they are located in the trigone.     

Formation and propagation of brain oedema fluid around human brain metastases. A CT study

Summary Computerized tomography (CT) was used to examine the timecourse of the propagation of extravasated contrast medium from small brain metastases into the peritumoural oedematous white matter, following infusion of 200 ml of meglumine amidtrizoate for 3 hours. Four patients with a metastatic brain tumour were examined. CT scans at identical levels were taken 1.5, 3, 6, 9, and 12 hours after start of contrast infusion. Following 4–7 days of dexamethasone treatment (8–12mg/day i.v.) the examination was repeated. A contrast-enhanced area was observed surrounding the clearly delineated tumours, expanding gradually in a circular fashion into the peritumoural white matter oedema. The expanding circular enhancement was measured planimetrically on the various scans. From these values, the increase in radius/hr respectively in volume/hr was calculated, assuming a spherical geometry. This enabled a determination of the rate of oedema fluid formation and of the speed of oedema fluid propagation. The formation rate of oedema fluid amounted to 0.5–3.2ml/hour and the speed of oedema fluid spreading to 1.9 mm/hour. Following treatment with dexamethasone the formation rate of oedema fluid is reduced by 30–50%. The important clinical implications of these new findings are discussed.     

The Application of Image Fusion in Stereotactic Brachytherapy of Brain Tumours

Summary  Background. The visualization of any morphological volume (i.e. CT, MRI) together with an additional second morphological volume (i.e. CT, MRI) or functional data set, which may come from SPECT or PET, is a new method for treatment planning, verification and follow-up of interstitial irradiation.  Method. The authors present their experience on interstitial irradiation of brain tumours with stereotactically implanted I-125 seeds supported by image fusion. The image fusion was performed by the BrainLab-Target 1.13 software on Alfa 430 (Digital) workstation before, during, and after interstitial irradiation of brain tumours with Iodine¹²⁵ seeds.  Results and Interpretation. On the basis of 20 brachytherapeutic image fusion of stereotactic CT (slices with fiducials) with additional stereotactic CT, MRI, PET and SPECT images provides more accurate and precise target volume, more exact localization of catheters and isotope seeds (verification fusion), differentiation between the localization and amount of the necrotic and proliferating parts of the tumours and shows the volume changes in consequence of interstitial irradiation. The image fusion should help to improve the accuracy and minimize the perifocal morbidity of interstitial irradiation.     

Decompressive frontal lobe resections and brain oedema

Summary Thirteen patients with expanding mass lesions underwent postoperative serial CT scanning after frontal lobe resection. Cases with malignant tumours and significant preoperative oedema showed a rapid postoperative filling of the resection cavity which presumably reflects increased intracranial pressure. Cases with more benign lesions without significant preoperative oedema continuously maintained an empty resection cavity. The results suggest that the clinical outcome after frontal lobe resection can be predicted from preoperative CT scans.     

Spatial and quantitative distribution of human peritumoural brain oedema in computerized tomography

Computerized tomography (CT) was used to study the pathways of oedema spreading in man. Based on the assumption that local changes in CT numbers in oedematous white matter closely correspond to changes in tissue water content, CT numbers of consecutive tissue blocks of 3.0-3.6 mm were examined in the main directions of oedema spreading: towards the deep white matter, towards the cortex and towards the ventricle. Tumours with oedema grade II and III showed a reduction of CT number of 10 +/- 1.8. The corresponding increase in water content of about 10-12% seems to be an upper limit of fluid accumulation in the white matter. From this oedema centre, water content very slowly and gradually decreased along the oedema projection into the deep white matter. In contrast, if oedema reached the cortex of adjacent gyri, the decline in water content was very sharp. A similar observation was made in the external capsule where oedema sharply declined at the border to the adjacent grey matter, putamen and claustrum. Oedema projection towards the ventricle showed a nearly uniform magnitude from the centre to the ventricular lining, suggesting a certain resistance by a limited capacity of transependymal drainage of oedema fluid. It is assumed that the spatial distribution and extension of oedema around a brain tumour is determined by a system of differential resistance to fluid movement in the following order: grey matter--ventricular lining--white matter.     

数字化骨科临床研究平台的构建及应用

目的 构建一组能在个人电脑(PC)上高速运行的三维可视化数字骨科临床研究平台系统.方法 2007年1月至2009年6月,收集三组资料,包括:自多层螺旋CT机图像工作站导出的300余例涉及骨创伤、关节、脊柱、骨肿瘤患者的薄层原始数据(DICOM格式);部分应用较为广泛的内置入物器械原型;20名健康志愿者(男10名,女10名;年龄21～30岁,平均24.5岁)的全身多层螺旋CT机扫描后的薄层原始数据.应用计算机及信息通讯领域的前沿技术,通过改进算法、改进人机交互方式、软硬件性能优化及相关逆向工程技术,创建一组能容纳海量数据及便于临床医牛广泛参与的数字化骨科临床研究平台软件包.结果 通过整合交叉学科前沿技术及大量的创新性工作,创建多功能数字化骨科临床研究平台,并将其命名为Superlmage系统.Superlmage系统能在目前丰流配置的PC上高速运行,自由编辑,兼容Windows XP/Vista、Unix及Linux等操作系统,数据读取支持主流品牌CT机导出的DICOM3.0标准数据,并实现了高精度的三维霞建成像;伪彩渲染的多平面重组成像;高速、便捷的三维图像交互式分割及编辑.SuperImage系统还附带一组信息丰富的数字化资料库,包括三维数字化骨骼、数字化内置人物虚拟模型器械库及患者数字化信息资料库,且支持数字化远程动态信息交互.结论 数字化骨科临床研究平台可满足临床医生的日常工作及科研需求,如精准的术前设计、术后随访、高败的数字化资料管理、远程信息交互、仿真的数字化虚拟教学及部分数字骨科解剖学研究等.     

Preoperative Functional Magnetic Resonance Imaging (fMRI) of the Motor System in Patients with Tumours in the Parietal Lobe

Summary  Intracranial lesions may compromise structures critical for motor performance, and mapping of the cortex, especially of the motor hand area, is important to reduce postoperative morbidity. We investigated nine patients with parietal lobe tumours and used functional MRI sensitized to changes in blood oxygenation to define the different motor areas, especially the primary sensorimotor cortex, in relation to the localization of the tumour. Activation was determined by pixel-by-pixel correlation of the signal intensity time course with a reference waveform equivalent to the stimulus protocol. All subjects showed significant activation of the primary sensorimotor cortex while performing a finger opposition task with the affected and unaffected side. In five patients the finger opposition task additionally activated the ipsilateral sensorimotor cortex and the supplementary motor area (SMA). Extension and flexion of the foot, additionally performed in two patients, also activated the sensorimotor cortex, in one case within the perifocal oedema of the tumour. Tumour localization near the central sulcus induced displacement of the sensorimotor cortex as compared to the unaffected side in all patients with a relevant mass effect. The results of our study demonstrate that functional MRI at 1.5 T with a clinically used tomograph can reproducibly localize critical brain regions in patients with intracranial lesions.     

Angiogenesis and Brain Oedema in Intracranial Meningiomas: Influence of Vascular Endothelial Growth Factor

Summary The correlation between angiographic neovascularization, peritumoural brain oedema (PTBOe) and the expression of vascular endothelial growth factor (VEGF) , was analysed in 30 patients with intracranial meningiomas. Pre-operative angiograms were examined for the existence of either an exclusively dural tumour blush or an additionally pial tumour supply from cerebral arteries. Furthermore the presence of macroscopic tumour-neovascularization and dysplastic changes of tumour-draining cerebral veins was evaluated. VEGF expression was investigated on histological tissue samples, using immunohistochemical techniques. VEGF immunohistochemistry and neuroradiological evaluations were performed in double blind fashion. Tumour volume and the amount of oedema were calculated by computerized tomography (CT) or magnetic resonance imaging (MRI). The oedema-tumour volume ratio was defined as oedema index (OeI). Compared to VEGF-negative meningiomas, tumours with striking VEGF staining revealed a significant higher mean oedema index (OeI=4,2 vs. OeI=1,5; p<0.018), and a higher oedema incidence (91,7% vs. 44,4%; p<0.046). Equally, meningiomas with additionally tumour supply from cerebral arteries were associated with a significant higher mean OeI (OeI=4.1 vs. OeI=1.2; p<0.01) and oedema incidence (94,7% vs. 20,0%; p<0,0023) than meningiomas with exclusively tumour supply from dural arteries. All meningiomas with striking VEGF-expression were associated with vascular tumour supply from cerebral arteries, but VEGF-negative tumours only in 50% (p<0.029). These data suggest a link between VEGF-expression, arterial tumour supply and peritumoural brain oedema. The development of tumour supply from cerebral arteries may be important for formation of meningioma-related oedema. Therefore, VEGF may represent a potent mediator in the evolution of this type of vascularization in meningiomas.     

Small bowel tumours: a 10 year experience in four Sydney teaching hospitals

BACKGROUND: Small bowel tumours are uncommon and can have a long delay prior to diagnosis. The present study aims to compare the use of computed tomography (CT) and contrast small bowel series (SBS) in their diagnosis and to outline the clinical features of small bowel tumours. METHODS: A retrospective, case note study was conducted between 1990 and 2000 in four Sydney teaching hospitals. The data collected included clinical features, investigations and tumour characteristics. RESULTS: One hundred and sixty-six people with small bowel tumours were identified (91 malignant; 75 benign). Malignant tumours consisted of adenocarcinomas (31%), carcinoid tumours (12%), lymphomas (7%) and leiomyosarcomas (5%). Benign tumours consisted of adenomas (22%), hamartomas (13%), leiomyomas (4%), inflammatory polyps (4%) and hyperplastic polyps (2%) and a benign schwannoma (1%). Adenocarcinomas were mainly located in the duodenum (P < 0.001) and carcinoid tumours in the ileum (P < 0.001). Malignant tumours were associated with a higher proportion of symptoms (P < 0.01), signs (P < 0.001) and episodes of small bowel obstruction (P < 0.01). Abdominal CT scans demonstrated a greater sensitivity (87.7%) than SBS (72.9%) with a slightly improved sensitivity when both investigations were used (89.3%). Abdominal ultrasound had a lower sensitivity than both of the above investigations of 65%. Gastroduodenoscopy had a sensitivity of 90% for diagnosing duodenal tumours. Operative procedures were performed on 92 patients with a preoperative diagnosis made in 77%. Metastatic spread of malignant tumours was evident in 46%. The sites of spread were to lymph nodes (23%), liver (21%) and distant locations (2%) at diagnosis. CONCLUSIONS: Malignant small bowel tumours are more likely to produce symptoms and signs than benign tumours, particularly caused by small bowel obstruction. Abdominal CT is the best radiological investigation for small bowel tumours and has a slight complimentary effect with SBS in improving the chances of detection. Gastroduodenoscopy remains the best investigation of duodenal tumours.     

Intracranial meningiomas in the elderly (over 70 years old)

Summary The decision to operate on a patient older than 70 years for an intracranial meningioma is always difficult. Therefore a series of meningiomas treated surgically in 30 cases older than 70 years has been reconsidered and studied according to the following parameters: Karnofsky's rating scale, physiological status of the patient (A.S.A. criteria), perifocal oedema and mass effect.The locations of the meningiomas were: convexity¹³, parasagittal⁶, falx², pterion (sphenoid ridge)⁵, orbito-cranial³, jugum sphenoidale¹, tentorium (occipital)¹.Postoperative survival at day 30 shows a mortality rate of 23% which increases to 37% at day 90 including causes like decubitus ulcers and 3 cases of fatal pulmonary embolism. In a comparable series of 31 cases from 60 to 70 years, mortality rate was only 16% at day 90.Two parameters seem essential for quantifying surgical risk: clinical status, oedema and mass effect, evaluated by CT scan. The best conditions seem combined when Karnofsky rating scale is higher than or equal to 50 with no or only limited perifocal hypodensity and without mass effect.Although meningiomas may remain dormant for many years or can be kept under control medically for some time, their development is unpredictable. We think therefore that a reasonable surgical risk can be taken on patients with good physical status and favourable parameters at the time of diagnosis, particulary if the meningioma is located at the convexity where the risk of recurrence is minimal. On the other hand, patients with unfavourable parameters are not recommended for surgery.     

Oedema along the optic tracts due to pituitary metastasis

The MRI finding of oedema along the optic tract has been reported in patients with craniopharyngioma, as a useful diagnostic sign among common pituitary tumours. We report two patients with pituitary metastasis with this MRI finding. A 59-year-old woman and a 54-year-old man had diabetes insipidus and extraocular impairment due to a pituitary metastasis tracts. To our knowledge, this is the first MRI report of oedema along the optic pathway due to pituitary metastasis. Our cases and review of literature indicate that this MRI sign is non-specific. Appearance of the oedema well corresponded to the initiation of visual complaint, which make a good contrast to reported clinical presentations of craniopharyngioma. Clinical significance and pathomechanism of this MRI sign are discussed.     

Preventive neurosurgery: population-wide check-up examinations and correction of asymptomatic pathologies of the nervous system

Summary Background. Prevention in healthcare is attracting more and more attention. Early identification and correction of anomalies harbouring the risk of a catastrophic event such as aneurysms is the principal rationale for brain check-up programmes. The other aim of preventive screening is to identify progressive lesions with little reversibility such as gliomas. The purpose of the current analysis is to review the frequency of the various incidental findings, the inherent risk and the therapeutic options. Rationale for check-up imaging and preventive treatment. The average prevalence of asymptomatic intracranial benign tumours, aneurysms and carotid stenoses must be estimated as approximately 1% each. Meningiomas, aneurysms and carotid stenosis become more frequent with increasing age. Mainly vascular anomalies harbour a risk of a catastrophic event, i.e. carotid stenosis and intracranial aneurysms. Only gliomas potentially lose reversibility with time passing. The case of glioma appears to be lost since asymptomatic gliomas are extremely rarely identified on screening examinations, and on the other hand current treatment series do not support that infiltrating gliomas can be cured if only treated early enough. Treatment of the benign tumours, hydrocephalus and arachnoid cysts in the asymptomatic stage does not appear to provide any benefit. Rationale for genetic screening. A number of intracranial tumours, vascular anomalies and degenerative changes are genetically determined. Examples are neurofibromatosis, tuberous sclerosis, von Hippel-Lindau disease and Rendu-Osler’s disease. Although familial clustering of aneurysms is well known, the exact genetic anomaly is unknown and probably several genes play a role. Because of the variable penetrance of the inherited disorders with known genetic alterations, screening of affected families is recommended. The conditions are too rare to justify screening of the entire population. Apolipoprotein E genotype is the only accepted predictor of dementia. Routine screening APOE may be considered today, but is highly problematic due to the lack of clear consequences and the potentially negative psychological impact. Costs. Implementation of population-wide screening programmes and preventive measures would lead to a substantial additional financial burden. Brain-check-up programmes cannot be considered in isolation. Cardiovascular and oncological programmes would also have to be included from that point of view. Conclusions. Population-wide screening with regard to intracranial aneurysms or carotid stenosis with non-invasive imaging techniques and preventive surgery/endovascular therapy can be justified, provided that treatment-associated morbidity is very low. There is no evidence for the rationale of screening for asymptomatic intracranial tumours, cysts or hydrocephalus. Genetic screening cannot be generally recommended, except among families affected by inherited conditions.     

Role of computeric tomography and magnetic resonance imaging in diagnosis of inflammatory diseases of sacro-ileal joint

Sensitivity of computeric tomography (CT) and magnetic resonance imaging (MRI) for sacroileitis diagnosis was studied, optimal for MRI investigation was established. In 31 patients, owing obvious clinical signs of inflammatory sacroileitis (at average more than 5 mo duration of a low back pain) MRI of sacroiliac joint was conducted in a T1, T2 FS, 2D T2 FLASH regimes and after intravenous infusion of a contrast substance (gadolinium) - in a T1 FS regime, using system, owing a 1,5 T magnetic field intensity. The data obtained were compared with results of CT. Sacroileitis signs were revealed in 27 patients - according to CT data, and in 22 - MRI. CT have demonstrated as a more sensitive method of the bone erosion and sclerosis diagnosis, than MRI. MRI is more sensitive while revealing an active inflammatory process in the bone and joint space. While T1 FS application no additional information for sacroileitis diagnosis was obtained.     

A case report of intracerebral tuberculoma during antituberculous therapy

A case of multiple intracerebral tuberculoma occurred in the course of anti-tuberculous therapy is reported. A 16-year-old high school boy had been treated with isoniagid, streptomycin and paramino-salicylic acid on the tuberculous pleulitis for 3 months previously. He was admitted to our hospital because of progressive headache associated with vomiting. Neurological examination revealed bilateral full papilledema and incomplete bilateral abducens palsy. An immediate CT study with contrast enhancement demonstrated two small ring-like mass with considerable perifocal edema in the left temporal and occipital lobe, respectively. Intracerebral tuberculoma was considered to be most likely, so the patient was given antituberculous therapy with steroid and mannitol. However, despite of medical decompression, he developed intracranial hypertension aggravated, leading to removal of tumor 7 days after admission. Initially left temporal tuberculoma, which had more extensive and prominent perifocal edema, was successfully excised. The specimen was a walnut-sized granuloma with hard capsule including pus inside. Numerous tuberculous bacilli were identified with Ziel-Nielsen staining technique from the pus. Postoperative course was gratifying, and other tumor in the left occipital lobe, which was also diagnosed as tuberculoma, was treated with continuing administration of isoniagid, ethanbutol and rifampicin. However, the former two drugs were forced to be discontinued because of agranulocytosis. Only rifampicin was maintained for 2 months thereafter but no decrease of the size was observed in serial CT studies. Then left occipital tuberculoma was removed. The pathology was tuberculoma with positive bacilli staining. He discharged 1 month later without any neurological deficit but was on antituberculous therapy (rifampisin) as an outpatient for 3 years.(ABSTRACT TRUNCATED AT 250 WORDS)     

数字化骨库的建立及在骨肿瘤切除异体骨关节个体化重建中的应用

目的探讨数字化骨库建立的可行性,评价异体骨数字化对于导航下骨肿瘤切除异体骨重建的影响。方法采用CT扫描的方法,对骨库深低温冷冻保存的同种异体骨段进行扫描,通过三维重建建立数字化分析系统（数字化骨库）。利用数字化骨库,选择最佳匹配的骨关节重建材料,数据导人计算机导航系统,标定骨肿瘤切除和异体骨段的截骨范围,依据术前设计在导航下实施、监测。2009年11月至2011年11月,采用数字化骨库和导航辅助切除重建技术对6例关节周围恶性骨肿瘤进行治疗,患者平均年龄（27．2±9．1）岁,其中骨肉瘤3例,软骨肉瘤2例,尤文氏肉瘤1例;Enneking分期：ⅡA期2例,1IB期4例,术后评价肿瘤学结果和功能恢复情况。结果与常规异体植骨材料术前准备操作相比,数字化骨库建立后,大大缩短了异体骨关节材料的选配时间,同时明显地提高了选配的精确性。计算机导航辅助下进行肿瘤切除、异体骨关节切割以及关节力线监控,术中解剖注册点与CT三维虚拟影像匹配满意,注册误差（0．42±0．17）mm。术后影像显示肿瘤整块切除范围和异体骨关节截骨区域与术前计划完全一致,关节重建稳定,无肢体不等长和关节畸形。随访（19．3±0．7．1）个月,未见局部复发和远隔转移,无明显免疫排异反应,异体骨与宿主骨平均愈合时间（5．2±0．8）个月,无内固定松动、断裂和关节塌陷。MSTS93平均功能评分（26．2±4．1）分。结论数字化骨库的建立为术前选配同种异体骨材料提供了精细可靠的信息,结合计算机辅助导航,可以实现骨肿瘤切除异体骨关节重建的个性化设计要求,进一步提高保肢手术的安全性和效果。