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背景:髋臼恶性肿瘤切除重建的主要目的是在安全边缘切除肿瘤并最大限度获得骨盆稳定及下肢行走的功能。既往多是通过MRI、CT、X射线片等二维资料评估切除范围,具有相当的主观性,缺乏术前设计。计算机三维重建可从整体及各个切面评估肿瘤侵蚀范围,从而做到精确确定肿瘤切除的范围。目的:评估计算机辅助设计在髋臼恶性肿瘤治疗中的应用价值。方法:1例髋臼血管肉瘤患者,应用薄层CT扫描获取病变部位的二维数据,计算机三维重建解剖学模型,设计截骨范围、个体化髋臼假体及模拟手术过程。按照计算机辅助设计方案切除髋臼肿瘤组织,采用异体半骨盆+个体化全髋关节置换重建骨盆环及右髋关节。结果与结论:异体半骨盆+个体化全髋关节置换后2个月患者开始扶拐患肢不负重行走,6个月患者行走步态基本正常,右髋关节活动良好,无疼痛不适。置换后X射线片提示人工假体与骨盆匹配良好。置换后仅右髋关节外侧有少许皮肤麻木,无深静脉血栓、假体脱位、松动等并发症。提示计算机辅助设计在髋臼周围肿瘤的治疗中有着广阔应用前景,它使手术治疗提升到个体化治疗阶段,使手术更精确、更可靠、更方便,效果更佳。
Background: The primary objective of resection and reconstruction of acetabulum malignancies is to resect the tumor at a safe margin and to maximize pelvic stability and lower extremity walking. In the past, MRI, CT, X-ray and other two-dimensional data to assess the resection range, with considerable subjectivity, the lack of preoperative design. Three-dimensional computer reconstruction can assess the scope of tumor erosion from the whole and all aspects, so as to accurately determine the scope of tumor resection. Objective: To evaluate the value of computer-aided design in the treatment of acetabular malignancies. Methods: One patient with acetabular angiosarcoma was diagnosed by thin-section CT. Two-dimensional data of the lesion, three-dimensional computer reconstruction model, osteotomy range, individualized acetabular prosthesis and simulated operation were obtained. Acetabular tumor tissue was resected according to the computer aided design. Pelvic ring and right hip joint were reconstructed with allogeneic half pelvis + individualized total hip arthroplasty. RESULTS AND CONCLUSION: At 2 months after allogeneic total hip arthroplasty and individualized total hip replacement, the patients started to walk and crush the affected limbs without walking. The walking gait was normal at 6 months, and the right hip joint was well and had no pain or discomfort. X-ray replacement prosthesis and pelvis prompted good match. Only a little skin numbness outside the right hip after replacement, no deep venous thrombosis, prosthesis dislocation, loosening and other complications. It is suggested that computer-aided design has broad application prospects in the treatment of tumors around the acetabulum. It enhances the surgical treatment to the individualized treatment stage, making the operation more accurate, reliable, convenient and effective.