数字骨库的建立及其在骨肿瘤手术治疗中的应用

The computer assisted bone bank and its application in individual treatment of bone tumor

目的建立数字化骨库，并探讨其在骨肿瘤切除同种异体骨重建中的临床应用价值。方法采用薄层cT对现有骨库中的大段同种异体骨进行扫描，将所得断层数据输入自制的数字骨科管理软件，三维重建后建立数字化分析系统。利用数字化骨库找到匹配的骨重建材料，并在术前设计截骨范围和异体骨修整。2009年11月至2012年6月对11例骨肿瘤患者采用数字化骨库和计算机辅助导航技术进行手术治疗，男7例，女4例；年龄13—42岁，平均24．7岁；其中骨巨细胞瘤3例，骨肉瘤5例，软骨肉瘤2例，尤文氏肉瘤1例。术后复查患处X线片并采用肌肉骨骼肿瘤学会93（MSTS93）评分系统评价肿瘤学结果和功能恢复情况。结果应用数字化骨库可以明显缩短异体骨材料的选配时间，并明显提高异体骨选配的精确性。使用计算机辅助导航进行肿瘤切除大段同种异体骨重建，术前CT三维虚拟影像与实际解剖注册点匹配满意，注册误差平均为0．42mm。11例患者术后随访3～30个月，平均15．7个月；术后复查影像可见肿瘤切除范围与异体骨重建区域与术前计划完全吻合，肿瘤切除范围安全，边界完整，无肢体不等长或畸形发生；未见局部复发和远隔转移，无内固定松动、断裂和关节塌陷，无明显免疫排异反应；异体骨与宿主骨愈合时间5～7个月，平均6．3个月。MSTS93功能评分平均为25．7分。结论建立的数字化骨库可在术前精确选择同种异体骨并完成手术设计，结合计算机辅助导航技术可实现骨肿瘤切除、大段同种异体骨重建的个体化设计，可有效提高骨肿瘤手术治疗的安全和疗效。

Objective To investigate the clinical value of a computer assisted bone bank in bone tumor resection and structural allograft bone reconstruction with computer assisted navigation. Methods Bone allografts in the present conventional bone bank in Xijing Hospital were sectionally scanned by CT. Three-dimensional reconstructed images of the CT scans were saved and marked in the digital analytical system to establish a computer assisted bone bank. Before surgery three-dimensional reconstructed CT image data of the bone tumor were compared with the allogenic osteoarticular data in the digital bone bank to select an op- timum match in bone remodeling segments. Both data were imported at the . dicom 3.0 format into the navi- gational system to accurately locate borders of the tumor and to cut the allografl bone during the surgery pre- operatively designed with the aid of the digital bone bank to get a structural reconstruction. From November 2009 to June 2012, tumor resections and reconstructions under computer navigation assisted by the digital bone bank were performed in 6 patients with malignant bone tumors. The patients were 7 males and 4 females, aged from 13 to 42 years （average, 24.7 years） . There were 3 cases of giant cell tumor, 5 cases of os- teosarcoma, 2 cases of chondrosareoma and one case of Ewing sarcoma. The oncological and functional out- comes were postoperatively evaluated by the Musculoskeletal Tumor Society 93 （MSTS93） system. Results The computer assisted bone bank obviously shortened the time for selecting allograft bone materials before surgery and improved the matching accuracy, compared with routine preparation of allograft bone. The dis- section registration spots in the actual operations matched well with the preoperative three-dimensional recon- structed CT images before surgery, with an average registration error of 0.42 ram. The 11 patients were fol- lowed up from 3 to 30 months （average, 15.7 months） . Postoperative X-ray images showed that the tumor resection territory and the allograft bone cutting region were totally consistent with the preoperative design in all patients. No limb discrepancy or malformation was observed. No screw loosening or breakage or joint collapse occurred. No obvious immunity rejection, or local recurrence or remote metastasis was observed. The healing between a11ograft and host bone was achieved after an average of 6.3 months. The average MSTS93 functional score was 25.7 points. Conclusions A digital bone bank can provide accurate information for selecting allograft bone materials before surgery, and allows for individual design of resection and reconstruction proto- cols which, in combination with computer navigation, may improve the safety and effectiveness of a salvage limb operation.