计算机导航辅助骨样骨瘤的外科治疗

Computer navigation-guided excision of osteoid osteomas

目的探讨计算机导航技术在骨样骨瘤外科治疗中的意义。方法回顾性分析2008年1月至2009年12月应用计算机导航辅助切除骨样骨瘤手术26例患者的临床资料，其中男性23例，女性3例，平均年龄18岁（7～35岁）。26例患者肿瘤位于股骨干9例、股骨粗隆部4例、股骨颈2例、胫骨干5例、胫骨近端干骺端1例、髋臼2例、耻骨1例、脊柱附件1例、桡骨干1例。术前均经局部X线及CT扫描明确诊断。其中4例采用CT数据导航，22例采用Iso-C3DC型臂术中实时导航。术中导航指引定位，精确切除瘤巢。结果全部病例均完成导航手术，其中行开窗刮除12例、整块切除14例；植骨21例、未植骨5例。26例患者均经术中肉眼判定、术中导航指引器确认、术后X线和（或）CT扫描确认瘤巢去除充分。全部病例均经组织病理学确诊为骨样骨瘤，术后疼痛即刻缓解。全部病例均获随访，平均随访20．6个月（12～35个月），未见肿瘤复发和疼痛复发。结论将计算机导航技术应用于骨样骨瘤的外科治疗，不仅使术中瘤巢定位更精确，而且对于复杂部位瘤巢的切除可以达到骨结构微创治疗的目的。对于骨干部位的骨样骨瘤，Iso—C3DC型臂术中实时导航较CT数据导航更有帮助。

Objective To report the experience for the precision osteoid osteoma resection using computer navigation system. Methods Between January 2008 and December 2009, 26 surgical resections were performed for 26 patients who had osteoid osteoma with computer navigation system. There were 23 males and 3 females with an average age of 18 years （7 to 35）. Tumors were located at femoral shaft 9, femoral trochanter 4, femoral neck 2, tibial shaft 5, metaphysic of proximal tibia 1, acetabulum 2, pubis 1, vertebral appendix 1 and radial shaft 1. Pre-operative X-ray and CT of each patient was performed to confirm the diagnosis. It was carried out intraoperatively the process of CT-based navigation in 4 cases and intraoperative Iso-C three-dimensional navigation in 22 cases. The Navigation System software was Spine Navigation 1.2 in all cases. The Pointer was helpful to localize the lesion and precisely resected the lesion without removal of any excess bone. Results All the navigation operations were finished successfully with curettage for 12 and En Bloc resection for 14. Bone grafting was made in 21 cases and none in 3 cases. The completely clearance of nidus by intraoperative visual inspection and Pointer confirmation, postoperative X- ray and （or） CT scan was performed in all cases. All cases had histopathology diagnosis of osteoid osteoma and immediate pain relief after surgery. All cases were followed up for 20. 6 months averagely （ 12 to 35 months）. No local recurrence and pain relapse occurred. Conclusions The navigation system is very helpful for the precision tumor resection of nidus. Especially for the patients with osteoid osteoma located at diaphysis, Intraoperative Iso-C three-dimensional navigation is more useful.