摘要
目的分析CT/MRI图像融合及其衍生技术在骨盆恶性肿瘤手术切除与功能重建中的作用及意义。方法回顾分析2012年1月至2017年1月四川大学华西医院收治的126例骨盆恶性肿瘤患者的病历资料,从中选取10例接受基于CT/MRI图像融合的三维打印导板截骨辅助半骨盆切除假体重建手术患者。男6例,女4例,平均年龄31岁(17~54岁)。累及骨盆范围:Ⅱ区和Ⅲ区5例,Ⅰ区和Ⅳ区3例,Ⅰ区、Ⅱ区和Ⅳ区2例。术前经活检或前次手术明确病理诊断:骨肉瘤4例,软骨肉瘤2例,侵袭性骨巨细胞瘤2例,转移性腺癌1例,浆细胞瘤1例。基于CT/MRI图像融合技术进行计算机模拟手术,通过三维打印模型体外模拟手术优化手术方案,运用计算机辅助设计(CAD)和三维打印技术指导手术切除与功能重建。分析肿瘤切除的外科边界、手术时间、术中出血量、术后并发症、住院时间以及术后功能恢复情况等。结果 10例患者均按术前计划完成手术。肿瘤标本经病理学验证为广泛性切除7例,边缘性切除3例。中位随访时间8个月(3~48个月),平均手术时间5.8 h(4~7 h),平均术中出血量1 239 ml(600~2 200 ml),平均住院时间15 d。术后均未出现肿瘤局部复发,2例患者因术后肺转移病死,1例患者浅部感染经换药后痊愈,2例患者深部感染经扩创后痊愈。1例患者假体脱位,予以手术切开复位,术后X线示假体位置良好。术后1,3,6及12个月平均MSTS 93评分别为18.4,22.8,23.2和23.8分。结论基于CT/MRI图像融合的三维打印导板辅助半骨盆切除技术有助于骨盆肿瘤的精确切除及重建。
】 Objective To evaluate the clinical significance of the application of CT/MRI fusion based excision and reconstruction for malignant pelvic tumor. Methods By retrospectively analyzing 126 patients with malignant pelvic tumor treated in West China Hospital, Sichuan University from January 2012 to January 2017, 10 patients underwent CT/MRI fusion based surgery were included. There were 6 males and 4 females with an average age of 31 years （ ranged from 17 to 54 years） . Involvement of pelvis included 5 patients for re-gion II , HI, 3 patients for region I , ]V, and 2 patients for region I , II , IV . Biopsy was done before surgery and the pathological diagnosis was confirmed 4 cases of osteosarcoma, 2 cases of chondrosarcoma, 2 cases of invasive giant cell bone tumor, one case of metastatic disease and one case of plasmacytoma. CT/MRI fusion based computerized surgery simulation was carried out, and 3D printing model was used to simulate the opera-tion in vitro to optimize the operation scheme. Computer aided design （ CAD） and 3D printing were used to guide surgical excision and functional reconstruction. The surgical margins, the duration of the operation, blood loss, complications ￡ind MSTS functional scores were analyzed. Results Ten patients underwent surgery as planned. Pathological examination showed that 7 patients achieved extensive resection and 3 patients achieved marginal resection. The mean follow-up time was 8 months （ ranged from 3 to 48 months）. The mean duration of operation was 5. 8 h （ranged from 4 to 7 h） . The average intraoperative blood loss was 1 239 ml （ranged from 600 to 2 200 ml） . No patients had local tumor recurrence. Two patients died of pulmonary metastasis. Three patients suffered infection. One patient had dislocation of the prosthesis and the X-ray showed the pros-thesis was in good position after open reduction. The functional score of MSTS at 1, 3,6 and 12 months postop- eratively were 18.4,
出处
《骨科临床与研究杂志》
2018年第2期86-91,100,共7页
Journal Of Clinical Orthopedics And Research
关键词
骨盆
肿瘤
继发原发性
计算机模拟
成像
三维
Pelvis
Neoplasms, second primary
Computer simulation
Imaging, three-dimensional
