3D打印髋臼导板辅助的骨盆肿瘤切除后精确性分析
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摘要
目的:分析3D打印技术在术前骨盆恶性肿瘤手术模拟与规划、术中切除、术后切除效果分析的应用及意义。方法:回顾性分析2014年11月至2018年11月在新疆医科大学第一附属医院收治的20例骨盆原发性恶性肿瘤患者的临床资料,其中男性11例,女性9例;平均年龄39.1(14～60)岁。骨肉瘤7例、软骨肉瘤12例、尤文肉瘤1例。参照Enneking骨盆分区,累及骨盆Ⅱ区和Ⅲ区6例,Ⅰ区和Ⅱ区6例,Ⅰ区和Ⅳ区8例。按是否采用3D打印截骨导板分为3D打印导板组(试验组)10例及常规组(对照组)10例,比较两组手术时间、出血量、功能评分、线性距离等情况。结果:20例患者手术顺利完成,获得整块切除;试验组手术时间(4.4±1.4)h,与对照组(4.5±1.4)h比较差异无统计学意义(P=0.83);试验组术中出血量(1980±1158)mL,与对照组(2785±1784)mL比较差异无统计学意义(P=0.16);试验组线性差距平均(3.8±1.9)cm,与对照组(8.7±1.0)cm比较差异有统计学意义(P=0.001)。结论:试验组可指导术中精确截骨,方便操作,简化手术具有推广应用价值;精确度方面优于对照组。
Objective: To analyze the application and significance of three-dimensional(3D) printing in the surgical simulation and planning for pelvic malignant tumors before the actual surgery, surgical resection, and postoperative resection effect analysis. Methods: A retrospective analysis was performed for 20 cases of primary pelvic malignant tumors in 11 male and 9 female patients with a mean age of 39.1 years(range, 14-60 years) who were admitted to Xinjiang University of Medical Science and Technology between January 2014 and January 2018. The tumors included osteosarcoma in 7 patients, chondrosarcoma in 12, and Ewing's sarcoma in one. According to the Enneking pelvic classification, 10 cases involved the pelvic Ⅱ area; 6, the pelvic Ⅲ area; 6, the pelvicⅠ and Ⅱ areas; and 8,the pelvic I and Ⅳ areas. According to whether or not a 3D-printed osteotomy guide plate was used, the cases were divided into a 3Dprinted guide plate group and a conventional group, with 10 cases in each group. Operation time, blood loss volume, function score,and linear distance deviation were compared between the two groups. Results: The operation was completed successfully with complete excision in 20 patients. The operation time in the 3D-printed guide plate group(4.4～1.4 h) was not statistically significantly different from that in the control group(4.5～1.4 h; P=0.83). No significant difference in intraoperative blood loss volume was found between the 3D-printed guide plate(1,980～1,158 mL) and control(2,785～1,784 mL; P=0.16) groups. The postoperative Musculoskeletal Tumor Society score(20.4～0.98) in the 3D-printed guide plate group showed no significant difference from that in the conventional group(20.2～1.29; P=0.78). The mean linear difference between the 3D-printed guide plate group(3.8～1.9 cm) and the conventional group(8.7～1.0) was statistically significant(P=0.001). Conclusions: The 3D-printed group was not significantly different from the conventional group in terms of operation time, blood loss volume, and function score but had better surgical resection accuracy than the conventional group.
Objective: To analyze the application and significance of three-dimensional(3D) printing in the surgical simulation and planning for pelvic malignant tumors before the actual surgery, surgical resection, and postoperative resection effect analysis. Methods: A retrospective analysis was performed for 20 cases of primary pelvic malignant tumors in 11 male and 9 female patients with a mean age of 39.1 years(range, 14-60 years) who were admitted to Xinjiang University of Medical Science and Technology between January 2014 and January 2018. The tumors included osteosarcoma in 7 patients, chondrosarcoma in 12, and Ewing's sarcoma in one. According to the Enneking pelvic classification, 10 cases involved the pelvic Ⅱ area; 6, the pelvic Ⅲ area; 6, the pelvicⅠ and Ⅱ areas; and 8,the pelvic I and Ⅳ areas. According to whether or not a 3D-printed osteotomy guide plate was used, the cases were divided into a 3Dprinted guide plate group and a conventional group, with 10 cases in each group. Operation time, blood loss volume, function score,and linear distance deviation were compared between the two groups. Results: The operation was completed successfully with complete excision in 20 patients. The operation time in the 3D-printed guide plate group(4.4～1.4 h) was not statistically significantly different from that in the control group(4.5～1.4 h; P=0.83). No significant difference in intraoperative blood loss volume was found between the 3D-printed guide plate(1,980～1,158 mL) and control(2,785～1,784 mL; P=0.16) groups. The postoperative Musculoskeletal Tumor Society score(20.4～0.98) in the 3D-printed guide plate group showed no significant difference from that in the conventional group(20.2～1.29; P=0.78). The mean linear difference between the 3D-printed guide plate group(3.8～1.9 cm) and the conventional group(8.7～1.0) was statistically significant(P=0.001). Conclusions: The 3D-printed group was not significantly different from the conventional group in terms of operation time, blood loss volume, and function score but had better surgical resection accuracy than the conventional group.
引文
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[14]Ma LM,zhou Y,zhu Y,et al.3D-printed guiding templates for improved osteosarcoma resection[J].Scientific Reports,2016,(6):23335.
[15]Tam MD,Laycock SD,Bell D,et al.3-D printout of a DICOM file to aid surgical planning in a 6 year old patient with a large scapular osteochondroma complicating congenital diaphyseal aclasia.[J].J Radiol Case Rep,2012,6(1):31-37.
[16]Enneking WF,Dunham W,Gebhardt MC.A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system[J].Clinical Orthopaedics Related Research,1993,(286):241-246.
[17]李慎江,蔺大伟,刘德斌,等.CR、CT、MRI在骨肿瘤诊断中的临床价值[J].中国矫形外科杂志.2006,(9):677-679.
[18]陈海松,韩燕,耿青,等.良恶性骨肿瘤的MRI鉴别诊断[J].磁共振成像,2014,(4):291-295
[19]牛晓辉,徐万鹏.我国骨盆恶性肿瘤外科治疗面临的难点和挑战[J].中国骨与关节杂志,2013,2(5):241-243.
[20]Virkus WW,Marshall D,Enneking WF,et al.The effect of contaminated surgical margins revisited[J].Clinical Orthopaedics Related Research,2002,(397):89-94.
[2]Giulia O,Norman J.The Epidemiology of Osteosarcoma[J].Pediatric Adolescent Osteosarcoma,2010,(152):3-13.
[3]Wingo PA,Tony T,Bolden S.Cancer statistics,1995[J].CA Cancer JClin,1995,45(1):8-30.
[4]Ozaki T,Rdl R,Gosheger G,et al.Sacral infiltration in pelvic sarcomas:joint infiltration analysisⅡ[J].Clin Orthop Relat Res,2003,(407):152-158.
[5]Wirbel RJ,Schulte M,Mutschler WE.Surgical treatment of pelvic sarcomas:oncologic and functional outcome[J].Clin Orthop Relat Res,2001,(390):190-205.
[6]Zeifang F,Buchner M,Zahlten-Hinguranage A,et al.Complications following operative treatment of primary malignant bone tumours in the pelvis[J].Eur J Surg Oncol,2004,30(8):893-899.
[7]王继方,胡永成,卢世璧.骨盆肿瘤外科治疗进展[J].中华骨科杂志,2000,20(增刊):61-63.
[8]Pring ME,Weber KL,Unni KK,et al.Chondrosarcoma of the pelvis.Areview of sixty-four cases[J].J Bone Joint Surg,2001,83(11):1630-1642.
[9]Kollender Y,Shabat S,Bickels J,et al.Internal hemipelvectomy for bone sarcomas in children and young adults:surgical considerations[J].Eur J Surg Oncol,2000,26(4):398-404.
[10]Wirbel RJ,Schulte M,Mutschler WE.Surgical treatment of pelvic sarcomas:oncologic and functional outcome[J].Clinical Orthopaedics and Related Research,2001,(390):190-205.
[11]付军,郭征,王臻,等.多种3D打印手术导板在骨肿瘤切除重建手术中的应用[J].中国修复重建外科杂志,2014,28(3):304-308.
[12]付军,王臻,郭征,等.数字化结合3D打印个体化导板的设计加工及其在骨肿瘤手术中的应用[J].中华创伤骨科杂志,2015,17(1):50-54.
[13]徐磊磊,田征,艾克拜尔·尤努斯,等.3D打印技术在骨肿瘤外科临床中的应用[J].中国修复重建外科杂志,2017,31(9):1069-1072.
[14]Ma LM,zhou Y,zhu Y,et al.3D-printed guiding templates for improved osteosarcoma resection[J].Scientific Reports,2016,(6):23335.
[15]Tam MD,Laycock SD,Bell D,et al.3-D printout of a DICOM file to aid surgical planning in a 6 year old patient with a large scapular osteochondroma complicating congenital diaphyseal aclasia.[J].J Radiol Case Rep,2012,6(1):31-37.
[16]Enneking WF,Dunham W,Gebhardt MC.A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system[J].Clinical Orthopaedics Related Research,1993,(286):241-246.
[17]李慎江,蔺大伟,刘德斌,等.CR、CT、MRI在骨肿瘤诊断中的临床价值[J].中国矫形外科杂志.2006,(9):677-679.
[18]陈海松,韩燕,耿青,等.良恶性骨肿瘤的MRI鉴别诊断[J].磁共振成像,2014,(4):291-295
[19]牛晓辉,徐万鹏.我国骨盆恶性肿瘤外科治疗面临的难点和挑战[J].中国骨与关节杂志,2013,2(5):241-243.
[20]Virkus WW,Marshall D,Enneking WF,et al.The effect of contaminated surgical margins revisited[J].Clinical Orthopaedics Related Research,2002,(397):89-94.