3D打印模型辅助肩胛骨软骨肉瘤的地图形外科切除

Partial Geographic Scapulectomy for Chondrosarcoma in Scapula with Assistance of 3Dprinted Model

目的描述一种地图形切除肩胛骨肿瘤的手术方法,并评估其切除精确性、肿瘤学预后和肩关节功能。方法回顾分析北京积水潭医院2013-2017年6例因肩胛骨肿瘤接受了3D打印模型辅助地图形外科切除手术患者的资料。术前采用CT扫描获得肿瘤数据。将图像数据集导入导航系统(Stryker Navigation),对肿瘤进行标记,术前设计截骨边缘。根据标有肿瘤信息的图像数据打印3D模型。术中按3D打印模型和术前设计截骨线完成手术。将术前计划和实际获得的切缘作比较。对外科边界、肿瘤局部复发、远处转移及肩关节功能进行评估。结果术前计划切缘21.0±8.1 mm,实际手术获得切缘22.0±6.6mm,两者匹配差值为1.0±5.3mm,差异无统计学意义(t=-0.795,P=0.437)。平均随访51.6月,未发现局部复发和远处转移,Neer肩关节功能评分96~100分,平均为98.2分,MSTS功能评分97%~100%,平均99%。结论使用3D打印模型辅助肩胛骨软骨肉瘤的地图形外科切除可以获得精确的肩胛骨部分切除及理想的肿瘤控制效果,术后肩关节功能满意。

Objective To describe a geographic surgical resection method for scapular tumors,and to evaluate its accuracy and the prognosis of the tumor and shoulder function.Methods From 2013 to 2017,6 patients underwent 3D-printed model assisted surgical excision in our hospital.Preoperative CT scan was performed to obtain the tumor data.The image data set was imported into the Navigation system(Stryker Navigation)to label the tumor,and the osteotomy edge was designed before the surgery.The 3D-printed model was printed from image data labeled with tumor information.The operation was performed according to the 3D-printed model and the preoperative design of the osteotomy line.Preoperative planning was compared with the actual margin achieved.The surgical margin,local recurrence,distant metastasis and shoulder function were evaluated.Results There was no significant difference between the planned margin and the actual margin(21.0±8.1 vs.22.0±6.6 mm,P=0.437).The mean follow-up was 51.6 months and no local recurrence or distant metastasis was found.The Neer shoulder function score was 96-100(mean score:98.2).The MSTS function score was 97%-100%(mean score:99%).Conclusion The accurate partial scapulectomy and ideal local tumor control could be achieved by the geographic resection of chondrosarcoma in the scapular with assistance of 3D-printed model.The post-operative function of shoulder is satisfactory.