计算机辅助原发性骨肿瘤的个性化手术方案设计

发布时间：2018-04-04 08:19

本文选题：计算机辅助设计　切入点：骨肿瘤　出处：《广州中医药大学》2015年硕士论文

【摘要】：目的：通过计算机辅助设计(CAD)、计算机辅助制作(CAD)、增量制作技术(RP)逆向工程(RE)等数字化技术,研究计算机辅助原发性骨肿瘤精确切除、大段骨缺损修复、肢体功能重建的方法,探讨计算机辅助技术治疗骨肿瘤与大段骨缺损的临床价值。方法：一、回顾性研究应用计算机辅助技术对骨肿瘤精确切除与术后大段骨缺损修复重建的病例,其中骶骨恶性肿瘤7例,股骨上段良性骨肿瘤8例,膝关节周围恶性骨肿瘤11例。所有病例术前都通过CT或MRI扫描获取肿瘤及其周围组织的二维图像数据,导入Mimicsl0.01软件三维重建骨关节三维模型、肿瘤侵袭或浸润模型；并根据肿瘤性质借助Imageware软件三维匹配、分析确定骨肿瘤外科切除边界；术前用Imageware.UG-NX软件设计个性化手术辅助模板,并采用数字化仿真模拟骨肿瘤精确切除和重建过程；最后按术前预设方案,在手术辅助模板引导下精确实施骨肿瘤切除、大段骨缺损修复重建手术。二.SPSS16.0软件进行统计学处理：计量资料使用平均数(x±s)表示,采用两独立样本t检验,P0.05为具有统计学意义；计数资料采用Fisher确切概率法,P0.05为具有统计学意义。结果：一、7例骶骨肿瘤均采取双侧钉棒固定腰椎和骨盆,手术时间为255-640min,平均475.86±119.91min；术中出血2000-7000,平均出血量为4725±1561.82m1。主要并发症：1例大小便不能控制和性功能丧失,1例未恢复性功能并术后伤口感染,1例因不慎摔伤致内固定棒断裂,1例骶骨脊索瘤术后3年复发。二、8例股骨上段肿瘤行大段异体骨+内固定的保髋重建术,术中出血400-2000m1,平均1181.21±721.08m1。随访12-38个月,末次随访记录：8例均未见肿瘤复发,未出现明显并发症,MSTS评分平均27.75±2.87分,优7例,良1例。三、11例计算机辅助膝关节周围骨肿瘤手术与14例常规手术效果比较：1.两组手术患者年龄、性别、术前疼痛评分(VAS评分)无统计学意义(p0.05)。2.术中肿瘤瘤段切除长度、手术出血量无统计学差异(p0.05)。3.术后1年复发率CAD手术组为9.09%,传统手术组为14.28%；并发症CAD手术组18.18%,传统手术组28.57%；Fisher确切概率法检验P0.05,尚不能证明两种手术方式在1年后复发率和并发症不同。4.保肢功能评分CAD手术组末次随访MSTS评分23-30分,其中优9例,良2例,平均为27.36±2.42分；传统手术组末次随访MSTS评分17-28分(排除1例截肢病例,13例纳入统计),其中优10例、良2例、中1例,平均为24.23±3.75分,采用两独立样本资料的t检验进行统计学分析,t=2.379,p0.05,具有统计学意义。患者膝关节主动屈曲活动度比较,CAD手术组的膝关节主动屈伸活动度80-120°,平均114.55±12.93°；传统手术组膝关节主动屈伸活动度70-120°(排除1例截肢病例,13例纳入统计),平均102.31±12.18°,采用两独立样本资料的t检验进行统计学分析,t=2.385,p0.05,具有统计学意义。结论：计算机辅助技术可以在保留最大范围正常骨骼的情况下精确切除骨肿瘤、个性化重建骨缺损区域和恢复骨关节功能,该技术与传统手术方法相比具有明显优势。
[Abstract]:Objective : To study the clinical value of computer - aided design ( CAD ) , computer - aided manufacturing ( CAD ) and incremental manufacturing ( RP ) reverse engineering ( RE ) .
and performing three - dimensional matching according to the tumor nature with the Imageware software to analyze and determine the resection boundary of the bone tumor ;
Preoperative Imageware . UG - NX software was used to design individualized surgical assistant template , and digital simulation was used to simulate the process of precise resection and reconstruction of bone tumor ;
At last , according to the pre - operative preset scheme , bone tumor resection and segmental bone defect repair and reconstruction were accurately performed under the guidance of the surgical assistant template . The second , SPSS 16.0 software was used for statistical treatment : the mean ( x 卤 s ) of the measurement data was expressed by the mean ( x 卤 s ) of the measurement data , and the difference was statistically significant with the two independent samples t test .
Results : One , seven cases of sacral tumors were treated with bilateral nail rods to fix the lumbar vertebrae and pelvis , the operation time was 255 - 640min , the mean 476.86 卤 119.91min ;
The average hemorrhagic volume was 4725 卤 1561 . 82m1 . Major complications were : 1 case was unable to control and lose sex function , 1 case did not recover sexual function and postoperative wound infection , 1 case had no significant complication after operation , 1 case had no significant complication , 1 case had no statistical difference ( p . 05 ) due to incomplete injury , 1 year recurrence rate CAD operation group was 9.09 % , and the traditional operation group was 14.28 % ;
The complications were 18.18 % in CAD group and 28.57 % in traditional operation group .
Fisher ' s exact probability method was used to test the difference of recurrence rate and complication after 1 year .
At the end of the traditional operation group , the MSTS score was 17 - 28 points ( excluding 1 amputation case , 13 cases included statistics ) . Among them , 10 cases were excellent , 2 cases were good , 1 case was middle , average 24.23 卤 3.75 points , t = 2.379 , p . 05 , which had statistical significance . Compared with the active flexion range of knee joint , the active flexion and extension activity of knee joint in CAD operation group was 80 - 120 掳 , mean 114.5 卤 12.93 掳 ;
Conclusion : Computer - assisted technique can accurately remove bone tumor , individualized reconstruction of bone defect area and restoration of bone joint function in the condition of retaining normal bone in the maximum range , which has obvious advantages compared with traditional surgical method .

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R738.1

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