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目的探讨计算机辅助设计(computer-aided design,CAD)在确定骨盆肿瘤切除边界、重建骨盆和髋关节结构中的应用价值。方法 2006年11月-2009年4月收治5例骨盆肿瘤患者。男3例,女2例;年龄24～62岁,平均36.4岁。骨肉瘤、骨巨细胞瘤、血管肉瘤各1例,软骨肉瘤2例。根据Enneking骨盆肿瘤分区:Ⅰ区、Ⅰ+Ⅱ区、Ⅲ区、Ⅳ区、Ⅰ+Ⅳ区各1例。按反求工程的基本原理,采用CT、MRI扫描获取患者骨盆二维数据,计算机三维重建建立骨盆解剖模型,将解剖模型输入CAD软件精确界定肿瘤切除范围,并设计个性化辅助手术模板、个性化假体以及模拟肿瘤切除、骨缺损修复重建过程。术中按照CAD方案精确切除骨盆肿瘤组织,采用外形匹配的同种异体髂骨加内固定或同种异体髂骨加个性化假体修复肿瘤切除后骨缺损,重建骨盆。结果 5例患者均顺利完成手术,手术时间平均7.9 h,术中出血量平均3 125 mL。术后1例出现切口内积血,1例出现脑脊液漏,均对症处理后痊愈。5例均获随访,随访时间24～50个月,平均34.5个月。患者均于术后4～6周扶双拐部分负重行走,3～6个月恢复行走功能。2例于术后18个月局部复发,1例行局部肿瘤再切除术、1例行局部放疗,无再复发。术后24个月采用国际保肢学会(ISOLS)推荐的骨肿瘤保肢术疗效评价标准进行功能评定,获优2例,良3例。结论采用CAD设计的个性化辅助手术模板、个性化假体及模拟手术过程,保证了骨盆肿瘤切除的精确性和可靠性,将骨盆肿瘤的切除和功能重建提升到个体化治疗阶段,可获得较好的疗效。
Objective To investigate the value of computer-aided design (CAD) in determining pelvic tumor resection boundary and reconstruction pelvis and hip joint structure. Methods From November 2006 to April 2009, 5 patients with pelvic tumor were admitted. 3 males and 2 females; aged from 24 to 62 years old, with an average of 36.4 years old. Osteosarcoma, giant cell tumor of bone, angiosarcoma in 1 case, 2 cases of chondrosarcoma. According to Enneking pelvic tumor subdivision: Ⅰ area, Ⅰ + Ⅱ area, Ⅲ area, Ⅳ area, Ⅰ + Ⅳ area in 1 case. According to the basic principles of reverse engineering, the two-dimensional data of the pelvis were obtained by CT and MRI scanning, the pelvic anatomical model was established by computerized three-dimensional reconstruction, the anatomical model was imported into CAD software to define the scope of tumor resection, the personalized surgical template was designed and personalized Prosthesis and resection of tumor resection, bone defect repair and reconstruction process. Pelvic tumor was accurately resected according to the CAD protocol during surgery. Allogeneic iliac bone plus internal fixation or allogeneic iliac bone plus individualized prosthesis were used to repair the bone defect after tumor resection and to reconstruct the pelvis. Results All 5 patients underwent successful operation. The average operation time was 7.9 h. The average amount of blood loss during operation was 3 125 mL. One case of postoperative hemorrhage occurred in the incision, one case of cerebrospinal fluid leakage, were cured after symptomatic treatment. Five patients were followed up for 24-50 months with an average of 34.5 months. All the patients were supported with double-crutches for weight-bearing walking 4 to 6 weeks after operation and resumed walking function 3 to 6 months after operation. Two cases had local recurrence 18 months after operation. One case underwent local tumor resection and one case underwent local radiotherapy without recurrence. Twenty-four months after operation, functional assessment was performed according to the evaluation standard of curative effect of bone salvage by ISOLS. The results were excellent in 2 cases and good in 3 cases. Conclusion The CAD-designed personalized surgical template, personalized prosthesis and simulated surgical procedures to ensure the accuracy and reliability of pelvic tumor resection, pelvic tumor resection and functional reconstruction to enhance the individualized treatment phase can be obtained more Good effect.