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目的报告应用计算机导航技术辅助完成肢体骨臣细胞瘤病灶扩大切刮术,评估其临床意义。方法 2007年11月至2009年5月,对15例肢体长骨骨巨细胞瘤患者行计算机导航辅助病灶扩大切刮术。男性5例,女性10例,年龄14～54岁,平均31岁,位于股骨下端5例,胫骨上端9例和颈骨下端1例。原发骨巨细胞瘤9例,复发病例6例。将术前CT和MRI数据导入计算机导航系统的工作站,依据CT图像确定骨组织的侵袭范围,依据MRI确定髓内或软组织侵袭范围,将CT和MRI图像融合,识别肿瘤的边界,在CT图像中标记,供术中导航指引。术中按照术前标记操作,导航指引病灶开窗,肿瘤刮除,以高速磨钻精确扩大切刮范围,并精确评判外科切除边界,验证术者术前的手术计划和术中的操作结果。结果 15例患者全部随访,17-34个月,平均23.5个月,无术后复发。1例术后2周伤口深部感染,清创后两周伤口愈合,其余无伤口延迟愈合及关节感染发生。结论计算机导航技术有助于肢体骨巨细胞瘤病灶的扩大刮除精确手术,降低复发率,同时更多保留正常骨质。
Objective To report the application of computer navigation technology to assist the expansion of the limbs of the craniofacial tumor lesions, to assess its clinical significance. Methods From November 2007 to May 2009, 15 patients with giant cell tumor of limbal bone were enrolled in this study. There were 5 males and 10 females, aged from 14 to 54 years (average 31 years old), 5 in the lower femur, 9 in the upper tibia and 1 in the lower neck. 9 cases of primary giant cell tumor of bone, 6 cases of recurrent cases. The preoperative CT and MRI data were imported into the computer navigation system workstation to determine the extent of invasion of bone tissue based on CT images. The extent of intramedullary or soft tissue invasion was determined by MRI. The CT and MRI images were fused to identify the border of the tumor. Mark for guidance in navigation. According to the operation of preoperative mark, the navigation guide the window of the lesion, the curettage of the tumor, the accurate scaling of the surgical excision boundary with the high speed grinding drill, and the preoperative operation plan and operation result of the operation. Results All the 15 patients were followed up for 17-34 months with an average of 23.5 months without recurrence. One case had deep wound infection 2 weeks after operation, and the wound healed two weeks after debridement. The rest without delayed wound healing and joint infection occurred. CONCLUSION Computer navigation technique is helpful to expand and cure the giant cell tumor of bone and reduce the recurrence rate and retain more normal bone.