计算机导航辅助髋臼骨巨细胞瘤精确切除和全髋关节置换的临床效果

Computer navigation assisted precise resection of acetabular giant cell tumor and total hip replacement

目的对于累及髋臼前柱或后柱的骨巨细胞瘤,评价应用计算机导航辅助技术进行精确切除和全髋关节置换的临床效果。方法选取2013年6月至2016年1月北京积水潭医院收治的符合病例纳入标准且资料完整的3例骨盆骨巨细胞瘤患者,其中病灶累及髋臼前柱1例,累及髋臼后柱2例。3例患者均应用计算机导航辅助技术进行肿瘤切除和全髋假体置换,采用自体同侧股骨头填补前、后柱缺损。术后定期随访,并采用国际骨与软组织肿瘤协会(MSTS)评价系统评估患肢功能。结果平均随访时间为26.3个月(14~33个月)。外科边界均为边缘及以上切除。平均术中失血量为2 400 ml,平均手术时间为390 min。截至最近随访时间,无肿瘤复发和转移,未发生假体松动或脱位、假体周围骨折以及伤口感染等并发症,假体生存率为100%,平均MSTS评分为27分。结论对于累及髋臼前柱或后柱的骨巨细胞瘤,应用计算机导航辅助精确切除可获得安全的外科边界和良好的局部控制效果,患者对术后重建功能满意。

Objective To evaluate the clinical outcome of computer navigation assisted precise resection and total hip arthroplasty for giant cell tumor involving the anterior column or posterior column of the acetabulum.Methods A total of 3 cases of pelvic giant cell tumor in accordance with the inclusive conditions from June 2013 to January 2016 in Beijing Jishuitan Hospital were analyzed.The lesions were located in anterior column in one case and posterior column in 2 cases.Three cases underwent computed navigation assisted tumor resection and total hip replacement,and the ipsilateral femoral head was used to fill the front and posterior column defects.All patients were followed up regularly and evaluated by Musculoskeletal Tumor Society（MSTS）functional scores.Results The average follow-up period was 26.3 months（ranged from 14 to 33 months）.Surgical margins were marginal or wide resection in 3 cases.The average blood loss was 2 400 ml and the average operation time was 390 min.There was no tumor recurrence and metastasis.There was no complication such as prosthetic loosening,dislocation,peri-prosthetic fracture and wound infection,and the survival rate of the prosthesis was 100%in the latest follow-up.The average MSTS function score was 27.Conclusion For giant cell tumor involving anterior column or posterior column of the acetabulum,computer navigation assisted precise resection and total hip arthroplasty can obtain a safe surgical margin and a good local control,and higher patient satisfaction with postoperative function.