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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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

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http://www.sygkzz.com/EN/ OR http://www.sygkzz.com/EN/Y2021/V27/I8/684

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