计算机导航辅助髋臼肿瘤精确切除与重建

目的 探索髋臼恶性肿瘤精确切除与重建的有效方法,评价其临床治疗效果.方法 利用图像融合、逆向工程、计算机辅助设计与制造等技术,建立髋臼恶性肿瘤精确切除与重建的治疗流程,完成术前规划并制备个体化定制髋臼假体,利用计算机导航系统辅助手术实施,实现肿瘤的精确切除及假体安装.自2010年12月至2012年5月,采用该流程治疗3例髋臼恶性肿瘤患者,软骨肉瘤2例、原始神经外胚层肿瘤1例,均累及骨盆Ⅱ+Ⅲ区.采用国际骨肿瘤协会(Musculoskeletal Tumor Society,MSTS)功能评分评价患肢功能,统计并发症发生情况.结果 3例患者均成功获得精确的肿瘤切除与髋臼重建.1例患者术后因搬动失误发生髋关节脱位,予以闭合复位；该例患者术后出现下肢深静脉血栓形成,对症治疗后治愈.术后3例患者均获得随访,随访时间10～21个月.至末次随访时3例患者均无瘤生存,未见感染、假体松动、螺钉断裂等并发症.MSTS评分为18～26分.结论 计算机导航辅助肿瘤切除和个体化定制髋臼假体重建能够满足髋臼肿瘤精确切除和重建的要求,肿瘤切除彻底、髋臼重建满意、并发症发生率低、近期效果良好,是外科治疗恶性髋臼肿瘤的一种有效方法,其远期疗效有待于进一步观察.

Precision acetabular tumor resection and reconstruction using custom prosthesis with the help of Computer Assisted Navigation System

Objective To investigate an effective method to reconstruct acetabular defect using custom prosthesis after tumor En-bloc resection with the help of Computer Assisted Navigation System(CANS). Methods 3D model of image fusion was reconstructed using the preoperative CT and MRI data. The tumor invasion range, the safe resection boundaries and osteotomy planes were marked on the 3D model. A custom acetabular prosthesis was designed and manufactured using CAD/CAM techniques according to pelvic defects. With the help of CANS, the tumor was accurately resected and the custom prosthesis was fixed precisely according to the preoperative planning. We formulated the innovative treatment process. Between December 2010 and May 2012, 3 patients with primary malignant acetabular tumor underwent the treatment process．They were males，aged from 30 to 55 years．There were 2 cases of chondrosarcoma and 1 case of primitive neuroectodermal tumor (PNET)． The tumors involved zone Ⅱ+Ⅲ in all of cases. All 3 patients were followed up, and complications, MSTS score and prognosis were recorded． Results The tumors in all 3 cases were resected successfully，and the acetabular defects were reconstructed precisely with custom prosthesis． All the 3 patients were followed up for 12 to 21 months. At the final follow-up, 3 patients survived without recurrence. No such complications as deep infection, dislocation, prosthesis loosening and screw broken occurred during the follow-up period. The MSTS score was 18-26． Conclusion The process is effective for the treatment of acetabular tumors. Acetabular tumor can be En-bloc resected safely and custom prosthesis can be fixed precisely with the help of CANS. According to the process, accurate tumor resection and precise reconstruction can be achieved. The rate of complications is low. The short-term result is fine, while the long-term result needs further observation．