Navigation-assisted Surgery for Bone and Soft Tissue Tumors With Bony Extension
Navigation-assisted Surgery for Bone and Soft Tissue Tumors With Bony Extension
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DOI：
10.1007/s11999-011-2094-5
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发表时间：
2012-01-01
影响因子：
4.2
通讯作者：
Nakamura, Hiroaki
中科院分区：
文献类型：
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作者：
Ieguchi, Makoto;Hoshi, Manabu;Nakamura, Hiroaki
背景：20世纪90年代，导航系统被引入骨科手术。近年来，基于CT的导航系统因其精确度而在脊柱和关节置换手术中得到越来越广泛的应用。问题/目的本研究的目的是评价导航辅助切除骨和软组织肿瘤的准确性和有效性。方法2006年至2009年，我们对16例患者进行了导航辅助手术，男11例，女5例，年龄13~70岁，平均39岁。我们诊断出9个良性骨肿瘤和7个恶性骨和软组织肿瘤。2例恶性软组织肿瘤累及邻近骨骼。良性肿瘤切除9例，恶性肿瘤切除7例。在所有病例中，点配准方法都是使用放置在肿瘤周围的10个皮肤标记进行的。结果该系统由皮肤标记物确定，平均准确度为0.93 mm(0.6~1.2 mm)。所有活检和切除标本均通过病理检查和术后CT检查进行评估。计划切缘与术后CT或切除的组织标本的平均差值为0~4 mm。平均随访34个月(10~54个月)。除1例脊索瘤患者的跳跃转移切除外，无局部复发。导航辅助手术可以提供足够可靠、准确和微创的手术切除。
Background The navigation system was introduced to orthopaedic surgery in the 1990s. More recently, CT-based navigation systems have been used more commonly in spine and joint replacement surgery because of their precision.Questions/purposes The aim of our study was to evaluate the accuracy and efficacy of navigation-assisted excision of bone and soft tissue tumors.Methods From 2006 to 2009, we performed navigation-assisted surgery in 16 patients, 11 males and five females, with a mean age of 39 years (range, 13-70 years). We diagnosed nine benign bone tumors and seven malignant bone and soft tissue tumors. In two patients, the malignant soft tissue tumors infiltrated the adjacent bones. Nine excisional biopsies for benign tumors and seven en bloc excisions for malignant tumors were performed. In all cases, the point registration method was performed using 10 skin markers, which were placed around the tumor. Each excisional difference between the preoperative and postoperative plans was evaluated histologically or by postoperative CT.Results The mean accuracy of this system, which was determined using skin markers, was 0.93 mm (range, 0.6-1.2 mm). All biopsy and excision samples were evaluated by pathologic examination and postoperative CT imaging. The mean difference between the planned margin and postoperative CT or excised histologic specimen was 0 mm to 4 mm. The mean followup was 34 months (range, 10-54 months). There were no local recurrences, except for excision of skip metastases in a patient with a chordoma.Conclusion We report our experience with navigation-assisted surgery for bone and soft tissue tumors. Navigation-assisted surgery could be indicated for sufficiently reliable, accurate, and minimally invasive resections.