计算机三维重建技术在指导髋臼恶性肿瘤切除与骨盆重建中的应用.pdfVIP

· 5l8· 中国矫形外科杂志 2005年4月第13卷第7期 Orthop J Chin，Vo1．13，No．7 April 2005 摘 要 目的：探究计算机三维重建技术在模拟骨盆、确定恶性肿瘤切除范围、假体个体化设计等方面的意义 及实际应用效果。材料及方法：女性髋臼软骨肉瘤1例，病灶侵蚀髋臼底、髂骨、坐骨，盆腔内软组织浸润约lOcm： 作病灶及骨盆的CT扫描，计算机三维重建，运用激光快速成型技术，制出实物骨盆模型。根据模型确定截骨范围及 截骨标志点，模拟病灶切除。继续通过计算机，制作与切除病灶相匹配的髋臼假体，附带与周围骨盆组织完全服贴 的固定柄。通过假体与患者肿瘤骨盆模型模拟手术与假体装备。取Smith—Peterson及Radley联合入路，显露髋关节、 耻骨支、坐骨支，按三维重建模型标志点切除肿瘤、植入预制假体；假体分别以髂骨翼、耻骨、坐骨残余部分牢固 固定。骨水泥固定髋臼内衬，置换股骨头。结果：手术时间约7h，出血约2 000ml，摄片示肿瘤缺损消失，人工假体 与骨盆和谐匹配，髋关节活动良好。未出现神经损伤、深静脉栓塞、感染、脱位等现象，患者恢复良好。结论：计算 机三维重建技术可以为髋臼肿瘤的恰当切除、匹配髋臼假体的个体化制作及骨盆的良好重建提供指导。 关键词 髋臼； 恶性肿瘤； 三维； 切除； 重建 中图分类号 R687 文献标识码 A 文章编号 1005—8478(2005)O7—0518—03 Application of the computer 3D reconstruction in acetabular malignant tumor resection and pelvic reconstruction／／ ZHANG Quan，ZHOU Jian—wei，HUANG Huang—yuan，et a1．Department of Orthopaedics，Huashan Hospital，Fudan Universi一 ． Shanghai 200040 Abstract 0bjective：To evaluate the significance and effect of computer three dimension(3 D)reconstruction in pelvic modeling．region of tumor resecting，designing of personal prothesis and the performing of the operation．Method：One case of a woman with acetabular chondrosarcoma。wich erosed the base of acetabulum。the ilium，the ischium and soft tissues in pelvic kidney was infiltrated about lOcm．The three dimension(3D)reconstruction of the pelvic and disease area Was made．A pelvic modeling was made according to the 3 D reconstruction．Based on the model，the tumor was resected appropriately and a matching personal prosthesis was made and used to reconstruct the defect caused by tumor resection．Smith—Petson with Radley approaches was used．The tumor resecting and personal prosthesis inserting was just similar to the modeling process on the 3 D reconstruc— tion．Then the prosthesis was fixed with correspondent residual bon