计算机辅助骨盆恶性肿瘤的手术治疗.docVIP

　　计算机辅助骨盆恶性肿瘤的手术治疗 .L.编辑。 作者：张余 尹庆水 黄华扬 夏虹 张涛，徐亮，王庆，齐向东 【摘要】 [目的]探讨应用 计算 机辅助的骨盆恶性肿瘤病例手术范围和植入假体设计的手术 治疗 后的临床效果。[方法] 应用CT数据及快速成型技术，模拟骨盆肿瘤切除重建术，设计手术切除范围，制造病变骨盆精确模型和植入个体化假体;2003年6月～2007年7月，共有9位患者进行了肿瘤切除个体化人工半骨盆重建术，其中男3例，女6例，骨巨细胞瘤4例，脊索瘤2例，软骨肉瘤2例，骨肉瘤1例。根据Enneking骨盆肿瘤分区：Ⅱ区3例，同时累及Ⅱ区和Ⅲ区5例，同时累及Ⅰ 区、Ⅱ区、Ⅲ区、骶骨区(Ⅳ 区)1例。随访时间为12个月到5年。[结果]手术中病变切除彻底，假体安装顺利，术中平均出血4 700 ml，术后1例患者伤口内积血、感染，予以清创、灌洗引流后，选用敏感抗生素后痊愈。所有患者术后4～6周扶双拐部分负重行走，术后4个月逐渐弃拐， 3例(33%)患者复发，其中骨肉瘤1例，术后18个月死于双肺转移;软骨肉瘤1例，术后13个月局部复发，术后17个月死亡;1例脊索瘤术后半年复发，二次手术，半年后再次复发，放弃治疗，3个月后死亡。1例术后2年时出现螺钉松动，患者可持拐行走。其余5例患者假体无松动，患侧髋关节和对侧髋关节对称。[结论]计算机辅助下的骨盆恶性肿瘤的手术范围设计，使切除边缘更彻底，个体化的人工半骨盆，与患者骨盆形状高度一致，保证了手术的顺利进行和良好临床效果，该技术在骨盆恶性肿瘤的切除及重建中有着良好的应用前景。 【关键词】 骨盆; 肿瘤; 偏侧骨盆切除术; 计算机辅助设计 　　Abstract: [Objective]To discuss the surgical extension and clinical effects of CAD custom-made hemipelvic for treating malignant pelvic tumors. [Method]The pelvis model ulated bone resection and prosthesis design ed on the models.Surgical extension and made hemi-pelvic or and reconstruction by individualized hemi-pelvic from June 2003 to June 2007.The series prised three males and six females, four or, ta, tor the implantation of prosthesis ount of bleeding l on an average.One patient suffered from infection and recovered after debridement.All patients began non-onths.Three patients had local relapse, one osteosara patient died of lung metastasis at 18 months after operation, one chondrosara patient relapsed locally at 13 months after operation and died at 17 months after operation. One chordoma patient relapsed locally at 6 months operation and received the second operation. It onths after the second operation and died at 3 months.Bolt metric.[Conclusion]The surgical extension of tumor designed by puter aided technical makes thorough resection possible. The custom-made hemi-pelvic is highly similar to the pelvis of patient in appearance, akes the operation easy and produces good clinic results. The custom-made hemi-pelvic offers a good promise for the reconstruction o