摘要
目的研究多模态影像融合联合多介质3D打印技术在复杂颈椎管内外沟通性肿瘤的临床应用价值。方法对21例累及2个节段以上、脊柱骨质破坏、肿瘤包绕椎动脉的复杂颈椎管内外沟通性肿瘤患者应用多模态影像融合技术,从MRI、CT薄层扫描、CTA中分割提取肿瘤、血管、骨质组织结构数据信息进行融合重建,形成三维可视化的多组织数字模型,并通过多介质3D打印技术将模型实体化,用于手术计划及术中操作指导。结果本组患者均融合出满意的肿瘤、血管、脊柱骨质三介质的三维可视化数字模型,以及3D打印的肿瘤和毗邻结构实体模型。模型直观显示出肿瘤破坏椎弓根、小关节及椎体骨质的程度与范围,肿瘤包裹椎动脉的空间位置关系。根据三维可视化数字和3D实体模型设计手术入路、指导术中操作。21例患者的肿瘤均在镜下全切,其中9例患者因脊柱失稳行一期内固定;无死亡及瘫痪病例。术后2例患者出现新发局灶性神经根损伤症状。讨论多模态像融合联合多介质3D打印技术能直观显示出复杂椎管内外沟通肿瘤的瘤体与血管、骨质的三维空间位置关系,有助于手术规划及术中对神经血管和脊柱稳定性的保护,提高肿瘤全切率,降低并发症发生率,有显著的临床应用价值。
Objective To explore the clinical value of multimodal image fusion combined with multi-media 3D printing technology in complex cervical dumbbell tumors surgery.Methods 21 patients with complex cervical spinal canal internal and external communicating tumors involving more than two segments,spinal bone destruction and tumor surrounding vertebral artery were treated with multimodal image fusion technology.The data of tumor,blood vessel,bone and other tissue structures were extracted from MRI,CT thin-layer scanning and CTA for fusion and reconstruction to form a three-dimensional visual multi-tissue digital model.The model was materialized by multimedia 3D printing technology for operation planning,intraoperative guidance,operation propaganda and clinical teaching.Results All the 21 patients were reconstructed satisfactory 3D visualization digital models and 3D printed solid models of tumor,blood vessel and spine bone.The models intuitively showed the extent of destruction of pedicle,facet joint and vertebral bone,and the spatial relationship of vertebral artery wrapped by tumor.The three-dimensional digital model and 3D solid model were used to design the surgical approach and guide the operation.All 21 cases of tumors were completely removed under the microscope,and 9 cases were treated with primary internal fixation due to spinal instability.There was no death or paralysis case.Only 2 cases had new symptoms of local nerve root injury.Conclusions Multimodal image fusion combined with multimedia 3D printing technology can intuitively display the three-dimensional spatial relationship of tumor,blood vessels,bone,etc.,which is helpful for surgical planning,intraoperative neurovascular protection and spinal stability.It can improve the total tumor resection rate and reduce the complications.
作者
何光建
薛兴森
陈欣
张洪燕
刘静静
林江凯
储卫华
HE Guang-jian;XUE Xin-sen;CHEN Xin(Department of Neurosurgery,Southwest Hospital,Third Military Medical University(Army Medical University),Chongqing 400038,China)
出处
《临床神经外科杂志》
2021年第3期275-279,284,共6页
Journal of Clinical Neurosurgery
基金
国家重点研发计划项目(2016YFC1100500)。
