混合现实技术在骨与软组织肿瘤精准手术中的应用探索

目的 探讨混合现实技术在骨与软组织肿瘤外科手术治疗中的临床应用价值。方法 选取上海交通大学附属第一人民医院骨科腋窝软组织肿瘤48岁女性住院患者1例,术前行64排螺旋CT平扫和增强扫描、3.0 T MR平扫,获得DICOM原始数据,导入Visual Volume三维重构软件系统,对目标区域各种组织区分后行可视化边缘检测、分割、提取和测算,生成STL格式的三维网格模型,再将三维模型通过Hololens眼镜映射到真实世界形成混合现实三维影像,协助医生在术前进行手术设计、模拟手术操作以及与患者有效沟通,并在混合现实技术引导下行肿瘤切除术。结果 利用基于CT、MRI影像学原始数据的高清重建,在混合现实技术引导下,本例患者手术中可视化清晰显示骨骼、肿瘤组织与周围解剖结构,手术路径清晰,准确定位并于边界外完整切除肿瘤组织;肿瘤周围血管神经保留完整,术后肢体感觉、运动功能良好。术后病理诊断:神经鞘瘤。结论 混合现实技术可在骨与软组织肿瘤术中协助确定肿瘤边界并切除肿瘤,在骨与软组织肿瘤手术的个体化治疗上具有发展潜力。

Application and exploration of mixed reality technology in accurate operation of bone and soft tissue tumors

Objective To explore the application value of mixed reality technology in the surgical operation of bone and soft tissue tumors.Methods A 48-year-old female inpatient with axillary soft tissue tumor in the Department of Orthopedics of the First People's Hospital Affiliated to Shanghai Jiao Tong university was selected.The DICOM raw data of axillary soft tissue tumors on the patient by 64-slice CT scan and 3.0 T MR scan were obtained and its 3D model reconstruction was completed. Then the 3D model was mapped to the real world through hololens glasses to form mixed reality 3D images, which assisted doctors in preoperative surgical design, simulated surgical operation and effective communication with patients, and guided by mixed reality technology for tumor resection.Results The bone, tumor tissue and surrounding anatomical structure of the patient were visualized and clearly displayed in surgery by high-definition reconstruction based on original CT and MRI imaging data with the assistance of mixed reality. The operation pathway was clear, and the tumor tissue was accurately located and completely removed outside the boundary. The patient recovered after operation with normal activities of the limb. Blood vessels and nerves around the tumor retain complete. Postoperative pathological diagnosis was schwannoma.Conclusions The combination of mixed reality technology with bone and soft tissue tumor surgery has brought revolutionary progress to the clinical diagnosis and treatment. It has great application prospects in the surgical treatment of bone and soft tissue tumors.