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目的总结增强现实(augmented reality,AR)技术联合3-D打印技术行半椎体置换治疗椎旁巨大神经鞘膜瘤1例经验。方法 2017年3月收治1例66岁男性椎旁巨大神经鞘膜瘤患者。术前CT增强扫描显示,脊柱腰骶部右侧旁盆腔内见一8.9 cm×7.8 cm×7.6 cm大小的不均匀明显强化肿块。利用Mimics软件处理CT扫描数据,模拟手术切除肿瘤,设计L5、S1椎体模型,并3-D打印钛合金椎体。术中术者佩戴导入了术前重建AR影像的Hololens眼镜,彻底切除肿瘤后,植入打印钛合金椎体。结果患者手术顺利完成,手术时间245 min,术中出血量约1 200 m L。术后病理检查结果示:(腹膜后脊柱旁)神经鞘瘤。术后6个月随访,患者疼痛视觉模拟评分(VAS)由术前5分降至2分;X线片及CT复查示钛金属椎体呈部分骨性融合,位置良好,无断裂、脱出,椎体无塌陷。结论应用AR技术辅助肿瘤切除,联合3-D打印假体置换治疗椎旁巨大肿瘤可行。
Objective To summarize a case of augmentation reality (augmented reality, AR) combined with 3-D printing technique in the treatment of paravertebral giant nerve sheath tumor by hemi-vertebral body replacement. Methods One March 66-year-old man with paravertebral giant nerve sheath tumor was treated in March 2017. Preoperative CT enhanced scanning showed that there was a nonuniform and significant enhancement mass in the pelvic area of right lumbar and lateral sacral spine of 8.9 cm × 7.8 cm × 7.6 cm. CT scan data were processed using Mimics software to simulate surgically resected tumors, designing L5, S1 vertebral body models and 3-D printing of titanium alloy vertebral bodies. During the operation, Hollerns glasses with preoperative reconstruction of AR images were worn. The tumor was implanted completely and the titanium alloy vertebrae were implanted. Results The operation of the patient was successfully completed. The operation time was 245 min and the intraoperative blood loss was about 1,200 m L. Postoperative pathological examination results show: (retroperitoneal spine) schwannoma. Visual acuity score (VAS) decreased from 5 points before operation to 2 points after 6 months follow-up. The X-ray and CT findings showed that the titanium vertebral body was partially bony fusion with good location, no fracture and prolapse, Vertebral body without collapse. Conclusion The application of AR technology to assist tumor resection, combined with 3-D printing prosthesis replacement paravertebral giant tumor feasible.