计算机辅助设计在髋臼恶性肿瘤治疗中的应用:1例报告

背景:髋臼恶性肿瘤切除重建的主要目的是在安全边缘切除肿瘤并最大限度获得骨盆稳定及下肢行走的功能.既往多是通过MRI、CT、X射线片等二维资料评估切除范围,具有相当的主观性,缺乏术前设计.计算机三维重建可从整体及各个切面评估肿瘤侵蚀范围,从而做到精确确定肿瘤切除的范围.目的:评估计算机辅助设计在髋臼恶性肿瘤治疗中的应用价值.方法:1例髋臼血管肉瘤患者,应用薄层CT扫描获取病变部位的二维数据,计算机三维重建解剖学模型,设计截骨范围、个体化髋臼假体及模拟手术过程.按照计算机辅助设计方案切除髋臼肿瘤组织,采用异体半骨盆+个体化全髋关节置换重建骨盆环及右髋关节.结果与结论:异体半骨盆+个体化全髋关节置换后2个月患者开始扶拐患肢不负重行走,6个月患者行走步态基本正常,右髋关节活动良好,无疼痛不适.置换后X射线片提示人工假体与骨盆匹配良好.置换后仅右髋关节外侧有少许皮肤麻木,无深静脉血栓、假体脱位、松动等并发症.提示计算机辅助设计在髋臼周围肿瘤的治疗中有着广阔应用前景,它使手术治疗提升到个体化治疗阶段,使手术更精确、更可靠、更方便,效果更佳.

Application of computer aided design in the treatment of acetabular malignant tumor: One-case report

BACKGROUND: Acetabular malignant tumor reconstruction is to obtain pelvic stability and lower limb walking function to excise the tumor at safe margin.Excision range has been evaluated by MRI,CT,X-ray,which are subjective and lack preoperative design.Computer-aided three-dimensional reconstruction can evaluate tumor erosion range from all planes to accurately excise the tumor.OBJECTIVE: To evaluate the value of computer aided design in the treatment of acetabular malignant tumor.METHODS: One case with acetabular hemangiosarcoma was checked with lamellar CT scanning,which acquired some two-dimensional data in disease area.The three-dimensional reconstruction of anatomical model,design of cutting bone extent,design of individual prosthesis and sham operation were made by computer.Based on computer aided design proposal,acetabular tumor was resected,pelvic ring and right hip articulation were reconstructed with allogeneic semi-pelvis and individual total hip replacement.RESULTS AND CONCLUSION: The patient began to non-weight bearing walk with double crutches 2 months after operation.At6 months,the patient walked normally.The right hip joint motion was good with no pain.Postoperative X-ray film displayed individual prosthesis matched to pelvis.The patient fell a little numbness of skin in the lateral of right hip.No phlebothrombosis,prosthesis loosening or dislocation was found.Computer aided design has a good perspective of application in the treatment of acetabular malignant tumor.Individualized treatment can improve operation accuracy,reliability,convenience and curative effect.