计算机辅助技术在髋臼周围恶性肿瘤治疗中的应用研究

The application study of computer-aided technique in malignant tumors around the acetabulum

目的探讨计算机辅助技术在髋臼周围肿瘤手术中的应用研究及临床效果。方法应用CT数据及快速成型技术，模拟髋臼周围肿瘤切除术，设计手术切除范围，确定截骨面，模拟修复重建，制造病变髋臼精确模型和个体化假体后，进行手术治疗。2003年6月到2007年6月，共有8位患者应用计算机辅助技术进行了髋臼肿瘤切除重建术，其中男3例，女5例，骨巨细胞瘤4例，脊索瘤1例，软骨肉瘤2例，骨肉瘤1例。根据Enneking骨盆肿瘤分区：Ⅱ区3例，同时累及Ⅱ区和Ⅲ区5例。随访时间为2—6年。结果手术中病变切除彻底，假体安装顺利，术中平均出血5700ml。术后有2例（25％）患者复发，其中骨肉瘤1例，术后18个月死于双肺转移；软骨肉瘤1例，术后13个月局部复发，术后17个月死亡；1例术后2年时出现螺钉松动，并发股动脉损伤，行动脉修复术后，患者可持拐行走，其余5例患者假体无松动。肢体功能评分参照人工全髋关节置换术后Harris评分标准，60～69分1例，70～79分5例，80～90分2例。结论应用计算机辅助技术参与髋臼周围肿瘤的模拟切除重建，保证了手术的顺利进行和精确的假体重建，临床效果优良，有着良好的应用前景。

Objective To discuss the application study and the clinic effect of computer-aided technique in malignant tumors therapy around the acetabulum. Methods The pelvis model was generated with its CT data by rapid prototyping. Simulated bone resection and reconstruction were performed on the models. Then we designed surgical extension and made hemi-pelvic. 8 patients received resection of acetabular tumor and reconstruction based on computer-aided technique from June 2003 to June 2007. The series comprised 3 males and 5 females, 4 were diagnosed having giant cell tumor, 1 having chordoma, 2 having chondrosarcoma and 1 having osteosarcoma. According to Enneking＇ s division, region Ⅱ （ n = 3 ） , the region Ⅱ and m （ n = 5 ）. Results The patients were followed for 2 to 6 years. The resection of tumor and implantation of prosthesis were easily accessible. The amount of bleeding was 5700 ml on an average. 2 patients had local relapse, 1 osteosarcoma patient died of lung metastasis at 18 months after operation, 1 chondrosarcoma patient relapsed locally at 13 months after operation and died at 17 months after operation. Bolt was loosened in one patient two years after operation, complicated with injury of femoral artery, but the patient can walk with one crutch after the artery repair. No loosening was found in the 5 patients, according to Harris scoring criteria after total hip replacement, 1 patient scored 60 to 69, 5 patients scored 70 to 79, 2 patients scored 80 to 89 in limb function. Conclusions The simulated resection and reconstruction of malignant tumors around the acetabulum based on computer-aided technique, makes the operation easy and reconstruction precise, which produces good clinic results and offers a good promise for the application.