计算机导航辅助下胫骨肿瘤节段性切除的准确性研究

The accuracy of segmental resection of tibia tumors under the computer-assisted navigation

目的本研究旨在探讨使用计算机导航行胫骨肿瘤节段性切除的准确性。方法回顾性分析我科2009年12月至2015年6月7例使用计算机导航行胫骨肿瘤节段性切除者。男3例,女4例,中位年龄16(13~27)岁。骨肉瘤5例,软骨肉瘤、造釉细胞瘤各1例。患者术前行胫骨肿瘤增强CT及MRI检查。将CT及MRI数据导入计算机辅助导航工作站中进行术前设计,记录设计的瘤段截除长度及肿瘤边缘到近端截骨边界及远端截骨边界的距离。使用计算机辅助导航进行节段性切除,获得术后标本后将标本用甲醛溶液固定24 h,再用电锯将瘤段标本沿冠状面剖开,使用精度为毫米的直尺测量瘤段的长度,将该长度与术前设计的截骨长度进行比较。标本送病理科后由骨肿瘤病理医生制作切片,测量出肿瘤边缘到近端截骨边界及远端截骨边界的距离,将该距离与术前设计进行比较。结果术后标本瘤段长度与设计的截除长度进行比较,差值为(-2~2)mm,绝对值差异平均为1 mm,二者差异无统计学意义(P=0.70)。术后实际肿瘤边界减去术前设计边界为肿瘤边界差值,差值为(-2~2)mm,绝对值差异平均为1.4 mm,术后实际边界与设计边界差异无统计学意义(P=0.68)。结论本研究证实计算机导航技术辅助下进行胫骨肿瘤的节段性切除准确性高,可以满足保留关节等精确切除手术的要求。

Objective To evaluate the accuracy of segmental resection of tibia tumors under the computer-assisted navigation. Methods We retrospectively analyzed 7 tibia cases for segmental resection under navigation between Dec. 2009 and Jun. 2015. There were 3 males and 4 females. The median age was 16 years old（ range： 13-27 years）. There were 5 osteosarcomas, 1 chondrosarcoma and 1 adamantinoma. The pre-operative CT and MRI data were inputted into the working station for planning. The planned resection length, proximal and distal margin were recorded, which were compared with the specimen after surgery. Results The differences between the achieved and planned resection length ranged from -2 mm to 2 mm. The average difference for the absolute value was 1 mm. There were no significant differences, P = 0.70. The differences between the achieved and planned margin ranged from -2 mm to 2 mm. The average difference for the absolute value was 1.4 mm. There were no significant differences, P = 0.68. Conclusions This study demonstrates the high accuracy of segmental resection of tibia tumors under the computerassisted navigation. This technique can meet the demand for the accurate resection of the tibia tumor