导板联合导航技术用于骨盆肿瘤切除术后髋臼重建定位的研究

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摘要目的比较单纯使用导板和导板联合导航技术辅助骨盆肿瘤切除术后钉棒-髋臼支架重建定位的效果和肢体功能，探讨导板联合导航技术用于髋臼重建定位的优势。方法回顾性分析2013年1月至2015年12月在空军军医大学附属西京医院骨科治疗的29例骨盆原发恶性肿瘤患者。将患者分为两组：导板组13例，女5例，男8例；平均年龄(40.4±7.6)岁；其中骨肉瘤4例，未分化多形性肉瘤3例，尤文肉瘤1例，软骨肉瘤5例。导板联合导航组16例，女8例，男8例；平均年龄(35.6±5.6)岁；其中骨肉瘤4例，软骨肉瘤11例，未分化多形性肉瘤1例。术前根据患者骨盆薄层CT三维重建骨盆结构，模拟手术切除并设计和3D打印重建导板。导板组术中使用导板辅助髋臼定位和钉棒-髋臼支架重建骨盆环、全髋关节置换；导板联合导航组在使用导板初步定位后再使用导航进行校对和微调，随后进行重建。比较两组的手术时间、出血量、肢体功能、肿瘤控制效果和重建后髋臼的影像学测量数据。结果导板组手术时间(5.5±0.8)h，术中出血量(4800±580)mL；导板联合导航组手术时间(4.7±0.6)h，术中出血量(4600±477)mL，两组比较差异无统计学意义(P＞0.05)。末次随访时，导板联合导航组肢体功能按照国际肌肉骨骼肿瘤学会评分(musculoskeletal tumor society，MSTS)评分为(22.5±2.7)分，比导板组略高，但差异无统计学意义(P＞0.05)。重建术后X线及CT测量结果显示，无论是髋臼旋转中心与身体中线距离还是髋臼安放角度，导板联合导航组较单独使用导板组更接近于生理性重建，两组间差异有统计学意义(P＜0.05)。结论导板联合导航用于骨盆肿瘤切除术后髋臼定位既避免了单纯使用导航的费时和繁琐，又避免了单独使用导板造成的误差，该方法有较好的临床应用前景。

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	蔡青 1
	党竞医 2*
	付军 2
	刘冬 2
	朱东泽 2
	张昭 2
	刘鑫成 2
	范宏斌 2*

关键词 ： 3D打印, 导板, 计算机辅助手术, 骨盆肿瘤, 切除重建

Abstract：Objective PurposeTo compare the effect and limb function of the reconstruction of acetabular cage with screw rod after resection of pelvic tumor assisted by guide plate and guide plate combined navigation technology，and to explore the advantages of guide plate combined navigation technology in acetabular positioning.Methods Retrospective analysis was performed on 29 patients with primary malignant pelvic tumors treated in our department from January 2013 to December 2015.The patients were divided into guide plate group andguide plate combined navigation group.13 patients(5 females，8 males) with an average age of(40.4±7.6)years，including 4 osteosarcoma，3 undifferentiated polytypic sarcoma，1 Ewing sarcoma，and 5 chondrosarcoma were included in the guide plate group.And16 patients(8 females，8 males) with an average age of(35.6±5.6)years，including 4 osteosarcoma，11 chondrosarcoma，and 1 undifferentiated polytypic sarcomawere included in the guide plate combined navigation group.The pelvis structure was reconstructed preoperatively according to the patients' thin slice CT，and the guide plate was designed and 3D printed to assist surgical resection and reconstruction.In the guide plate group，the guide plate assisted acetabular positioning，the screw rod-acetabular reconstruction of the pelvic ring，and total hip arthroplasty were performed intraoperatively.In the guide plate combined navigation group，after preliminary positioning with guide plate，the navigation was used for calibration and fine-tuning.The time of operation，blood loss，limb function，tumor control and measurement of reconstructed acetabulum were compared between groups.Results In the guide plate group，the time of operation was(5.5±0.8)hours，and the intraoperative blood loss was(4 800±580)mL.In the guide plate combined navigation group，the time of operation was (4.7±0.6) hours，and the intraoperative blood loss was (4 600±477)mL.There was no significant difference between the two groups(P＞0.05).At the last follow-up，the MSTS score of the guided-plate combined navigation group was (22.5±2.7)，which was slightly higher than that of the guided-plate group，but there was no statistical difference(P＞0.05).X-ray and CT measurements after reconstruction showed that both the distance between the acetabular rotation center and the midline of the body and the angle of the acetabular placement were closer to the physiological reconstruction in the guide plate combined navigation group than in the guide plate alone group (P＜0.05).Conclusion The guide plate combined navigation for acetabular positioning after pelvic tumor resection avoids both the time-consuming and tedious use of navigation alone and the error caused by the use of the guide plate alone.This method has a good clinical application prospect.

Key words： 3D printing guide plate computer-assisted surgery pelvic tumor excision and reconstruction

基金资助:国家重点研发计划(2016YFB1101104)
陕西省重点研发计划(2018ZDXM-SF-075)

通讯作者: 范宏斌

作者简介: 蔡青(2000－ )，男，本科在读，空军军医大学临床医学系，710032。

引用本文:

蔡青 1，党竞医 2*，付军 2，刘冬 2，朱东泽 2，张昭 2，刘鑫成 2，范宏斌 2*. 导板联合导航技术用于骨盆肿瘤切除术后髋臼重建定位的研究[J]. 实用骨科杂志, 2021, 27(8): 684-735.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2021/V27/I8/684

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