计算机辅助导航技术在骶骨肿瘤外科治疗中的应用

Computer navigation aided precision excision for sacrum tumor

目的评估计算机辅助导航技术在术中指引骶骨肿瘤的骨性边界精确外科切除中的意义。方法2007年12月至2010年6月，对13例骶骨肿瘤患者实施计算机辅助导航的外科治疗，男5例，女8例；年龄21-69岁，平均44岁；肿瘤位于骶S3水平以上10例，S3水平以下3例。术前行穿刺活检或前次手术明确病理诊断，脊索瘤7例，骨巨细胞瘤4例，神经鞘瘤2例；复发病例5例，原发病例8例。术前将增强CT和MRI数据导入计算机导航工作站设计术前方案，利用影像融合技术明确病灶侵犯的髓内范围和骨外范围，设计截除瘤骨的范围并标记。术中10例利用点注册，实现手术区域和影像的配准，误差平均2．6mm；3例采用Iso—c术中扫描，实现手术区域和影像的即刻配准，而后再与术前CT或MR图像融合。术中按术前肿瘤切除计划，以指引器确认肿瘤切除的外科边界切除肿瘤。结果13例患者全部按术前计划完成手术，术后肿瘤标本经病理验证达到广泛切除2例，边缘切除4例，囊内扩大刮除7例。全部病例均获得随访，随访时间7-37个月，平均18个月。其中2例行囊内扩大刮除的患者复发，广泛切除和边缘切除的患者未见复发。结论术中导航技术为可视操作，可按术前计划切除骶骨肿瘤骨性外科边界，并使部分病例达到边缘或广泛切除，复发率低。

Objective To assess the clinical significance of the application of computer assisted navigation technology in excision for sacrum tumor. Methods From December 2007 to June 2009, 13 patients with sacrum tumor were treated with computer navigation assisted aggressive curettage. There were 5 males and 8 females, aged 21 to 69 years, with the mean age of 44 years, 10 cases were over the level of sacrum3 and 3 cases under the sacrum3. Pathologic diagnosis was chordoma in 7 cases, giant cell tumor in 4 cases and neurofibroma in 2 cases. Five cases were recurrence. The preoperative data of CT and MRI were input into the computer navigation workstation. CT images determined the scope of the invasion of tumor in bone tissue. MRI determined the scope of the invasion of tumor in soft tissue. The CT and MRI image fusion identified the precise boundaries of the tumor in CT images and made markers for navigation guidance in the operative in 10 cases. The Iso-c scan had been made for another 3 cases and fused the Iso-c images with preoperation CT images for improving the images quality. According to preoperative marker in CT images, the aggressive curettage were completed with the real time computer navigation for 7 cases, marginal resection in 4 cases and wicle resection in 2. The precise surgical removal of the lesions boundary were verified by computer navigation according to the preoperative planning. Results Thirteen patients were followed up for 7 to 37 months, an average of 18 months, no recurrence cases with marginal resection and wide resection. Two cases with aggressive curettage had recurrence. Conclusion Computer navigation technology helps to precise excision the sacrum tumors, to reduce the recurrence rate.