【摘要】 目的报告应用计算机导航技术辅助完成肢体骨臣细胞瘤病灶扩大切刮术,评估其临床意义。方法 2007年11月至2009年5月,对15例肢体长骨骨巨细胞瘤患者行计算机导航辅助病灶扩大切刮术。男性5例,女性10例,年龄14～54岁,平均31岁,位于股骨下端5例,胫骨上端9例和颈骨下端1例。原发骨巨细胞瘤9例,复发病例6例。将术前CT和MRI数据导入计算机导航系统的工作站,依据CT图像确定骨组织的侵袭范围,依据MRI确定髓内或软组织侵袭范围,将CT和MRI图像融合,识别肿瘤的边界,在CT图像中标记,供术中导航指引。术中按照术前标记操作,导航指引病灶开窗,肿瘤刮除,以高速磨钻精确扩大切刮范围,并精确评判外科切除边界,验证术者术前的手术计划和术中的操作结果。结果 15例患者全部随访,17-34个月,平均23.5个月,无术后复发。1例术后2周伤口深部感染,清创后两周伤口愈合,其余无伤口延迟愈合及关节感染发生。结论计算机导航技术有助于肢体骨巨细胞瘤病灶的扩大刮除精确手术,降低复发率,同时更多保留正常骨质。更多还原

【Abstract】 Objective To assess the clinical significance of computer navigation-assisted technology in wide curettage for giant cell tumor(GCT) of bone in extremities.Methods From November 2007 to May 2009,15 patients(5 males,10 females) with GCT of bone in extremities were treated with computer navigation-assisted wide curettage.The mean age was 31 years(range,14-54 years).Of the lesions,5 cases were in the distal femur,9 cases in the proximal tibia and 1 case in the distal tibia.9 cases had primary giant cell tumor and 6 cases sustained recurrence. The preoperative CT and MRI data were input into the computer navigation workstation.The scope of the invasion by GCT in bone tissue was determined by CT images.The scopes of the invasion of GCT in medullary cavity and soft tissue were indicated by MRI results.The CT and MRI images together identified the precise boundary of the tumor.In CT images,marks were made for intra-operative navigation-assisted guidance.According to preoperative marks in CT images,the surgery was completed with the real time computer navigation through lesion opening and tumor curettage. The high-speed burr expanded the scope of lesions.The precise surgical boundary for lesion curettage was verified by computer navigation according to the preoperative plans and intra-operative management.Results All of the 15 patients were followed up,with a mean period being 23.5 months(range,17-34 months).No postoperative recurrence was found. 1 case reported deep wound infection 2 weeks after operation.The wound was healed 2 weeks after debridement.The remaining cases had no delayed wound healing nor joint infection.Conclusions The computer navigation technique can assist in precise wide curettage for giant cell tumor of bone in extremities,reduce the recurrence rate,and retain more normal bone mass.更多还原