摘要
目的探讨混合现实技术在骨肿瘤精准外科治疗中的应用价值。方法回顾性分析2018年9月—2019年3月辽宁省肿瘤医院14例骨肿瘤患者临床资料,其中男7例、女7例,年龄13~57岁、平均32岁。肿瘤部位股骨远端4例、胫骨近端3例、肩胛骨3例、骨盆2例、肱骨近端1例、锁骨近端1例。恶性肿瘤11例,其中骨肉瘤6例、软骨肉瘤2例、横纹肌肉瘤1例、转移癌2例;良性肿瘤3例,其中骨巨细胞瘤1例、骨母细胞瘤1例、嗜酸细胞肉芽肿1例。所有患者术前采用640层螺旋CT扫描仪行肿瘤部位增强三维重建,收集患者CT原始DICOM数据,将其导入到三维医学影像工作站进行分割、重建、材质设定,通过"星图"混合现实影像系统获得全息影像数据。术前应用全息影像制定个体化手术方案,术中采用全身麻醉,按照术前规划完成手术。观察患者手术时间、术中出血量、术后并发症发生情况、肿瘤安全外科边界,假体置换患者对比术前、术后双下肢肢体长度差,末次随访采用肌肉骨骼肿瘤学会(MSTS)93评分标准对患肢功能进行评价。结果本组中14例患者在混合现实技术引导下准确定位,完整切除肿瘤组织。手术时间60~180 min,平均133 min。术中出血量50~1100 mL,平均364 mL。术后均无切口感染、皮肤坏死等并发症发生。6例行膝关节肿瘤型假体置换患者术前测量双下肢长度差1.3~6.5(3.70±1.87)mm,术后测量双下肢肢体差为1.7~4.9(2.95±1.24)mm,术前、术后双下肢肢体长度差比较,差异无统计学意义(t=0.672,P>0.05)。术后第3天复查MR检查或CT扫描评价外科手术边界,肿瘤完整切除,内固定物位置良好。14例患者均获随访,随访时间15~20个月,平均16个月。至末次随访MSTS评分为17~28分,平均23.9分;患肢功能优7例,良2例,可5例。随访期间14例患者无一例死亡,未见肿瘤复发及转移。结论通过混合现实技术提供的立体直观、全方位病变部位的解剖细节,可以辅助骨肿瘤患者术前手术规划,提高术中肿瘤切除精确性、安全性及组织重建的有效性,实现了骨肿瘤手术规划的可视化、个体化,具有临床推广价值。
Objective This study aims to explore the clinical application value of the mixed realistic surgery in the precise surgical treatment of the bone tumor.Methods The clinical data of 14 patients with bone tumor(7 males and 7 females,average age=32 years)who met the inclusion criteria from September 2018 to March 2019 were retrospectively analyzed.Among the tumor sites,4 cases of distal femur,3 cases of proximal tibia,3 cases of scapula,2 cases of pelvis,1 case in proximal humerus,and 1 case in proximal clavicle,were observed.Eleven cases of malignant tumors,including 6 cases of osteosarcoma,2 cases of chondrosarcoma,1 case of rhabdomyosarcoma,2 cases of metastatic carcinoma.Three cases of benign tumors,including 1 case of giant cell tumor of bone,1 case of osteoblastoma,and 1 case of eosinophilic granuloma,were observed.Before the surgery,all patients were preoperatively treated using a 640-slice spiral CT scanner for enhanced 3D reconstruction of the tumor site,and the original CT DICOM data of the patients were collected,which were imported into the 3D medical imaging workstation for segmentation,reconstruction,and material setting.Holographic image data were obtained through the"star map"mixed realistic imaging system.The preoperative hologram was used to make a personalized surgical plan,and general anesthesia was used during the operation.The operation was completed in accordance with the preoperative plan.The operative time,intraoperative blood loss,postoperative complications,and safe surgical boundary of tumor were observed.The limb length of the lower limbs before and after prosthesis replacement was determined.The function of the affected limb was evaluated in the final follow-up by using the Musculoskeletal Tumor Society(MSTS)93 scoring standard.Results In this group,14 patients were guided by the mixed reality technology for the accurate localization and the complete resection of tumor tissue.In six patients undergoing knee tumor prosthesis replacement,the preoperative measurement of the length difference of the lower limbs was 1.3-6.5(3.70±1.87)mm,and the postoperative measurement of the length difference of the lower limbs was 1.7-4.9(2.95±1.24)mm.No significant difference was observed in the length between the two lower limbs before and after the operation(t=0.672,P>0.05).The MR examination or the CT scan was performed three days after surgery to evaluate the surgical boundary.The tumor was completely removed,and the internal fixator was in good position.All 14 patients were followed up for 15-20 months(average=16 months).The MSTS score at the last follow-up was 17-28 points(average=23.9 points).The function of affected limb was excellent in seven cases and good in seven cases.During the follow-up period,none of the 14 patients died,and no tumor recurrence or metastasis was observed.Conclusions The stereoscopic and the comprehensive anatomical details of the lesion site provided by the mixed reality technology can assist the preoperative surgical planning;improve the accuracy,safety,and effectiveness of the intraoperative tumor resection;and realize the visualization and the individualization of the surgical planning of bone tumor and may be clinically promoted.
作者
高原
潘沨
张骏
邱恩铎
夏铁男
唐本森
邱冰
商冠宁
Gao Yuan;Pan Feng;Zhang Jun;Qiu Enduo;Xia Tienan;Tang Bensen;Qiu Bing;Shang Guanning(Department of Orthopedics,Guizhou Province Orthopedic Hospital,Guiyang 550000,China;Department of Bone and Soft Tissue Tumor Surgery,Liaoning Cancer Hospital&Institute,Shenyang 110042,China)
出处
《中华解剖与临床杂志》
2021年第2期162-167,共6页
Chinese Journal of Anatomy and Clinics
基金
国家癌症中心攀登基金(NCC201806B012)
辽宁省肿瘤医院—大连理工大学"医工交叉研究基金"项目(LD202004)。
关键词
骨肿瘤
混合现实技术
精准手术
应用
Bone neoplasms
Mixed reality technique
Precision surgery
Application
