Lee Hyun-Il, Shim Jong Sup, Jin Hee Jeong, Seo Sung Wook
Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea.
Comput Aided Surg. 2012;17(2):56-68. doi: 10.3109/10929088.2012.655780.
Adequate curettage of benign bone tumors located close to articular joints or neurovascular tissue is difficult without damaging those tissues. The purpose of this study was to evaluate the adequacy of tumor removal in computer-assisted curettage of benign bone tumors. The study is a prospective case series involving eight patients with benign bone tumors located near an articular joint or major neurovascular tissue. Image-to-patient registration with the navigation system was performed using paired-points methods in conjunction with CT images. A cortical window was created to visualize the tumor cavity. After removal of the gross tumor with sharp curettes, a specially designed burr attached to a navigation probe was used to monitor the location of the burr tip in real time. The high-speed burr extended the bony margin a few millimeters over the cavity wall. The empty cavity was then filled with bone cement. We assessed the accuracy of curettage and articular involvement by comparing pre- and post-operative CT images. In all cases, deeply seated or multi-cystic tumors were sufficiently removed according to the pre- and post-operative fusion CT images. The subchondral bone was punctured when the initial thickness of the subchondral bone was less than 2.5 mm. However, use of the computer-guided burr was safe if the thickness of the subchondral bone was greater than 3 mm. Computer-assisted curettage is a safe and useful method for localizing deeply seated benign bone tumors. However, use of the burr should be avoided when the bone thickness is less than 3 mm to avoid major tissue damage.
在不损伤关节或神经血管组织的情况下，对位于关节附近或神经血管组织附近的良性骨肿瘤进行充分刮除是困难的。本研究的目的是评估计算机辅助刮除良性骨肿瘤时肿瘤切除的充分性。该研究是一个前瞻性病例系列，涉及八名患有位于关节附近或主要神经血管组织附近的良性骨肿瘤的患者。使用配对点方法结合CT图像，通过导航系统进行图像到患者的配准。创建一个皮质窗口以可视化肿瘤腔。用锐利刮匙切除肉眼可见的肿瘤后，使用连接到导航探针的特殊设计的磨头实时监测磨头尖端的位置。高速磨头将骨边缘在腔壁上延伸几毫米。然后用骨水泥填充空腔。我们通过比较术前和术后CT图像来评估刮除的准确性和关节受累情况。在所有病例中，根据术前和术后融合CT图像，深部或多囊性肿瘤均被充分切除。当软骨下骨的初始厚度小于2.5毫米时，软骨下骨被穿刺。然而，如果软骨下骨的厚度大于3毫米，使用计算机引导的磨头是安全的。计算机辅助刮除是定位深部良性骨肿瘤的一种安全且有用的方法。然而，当骨厚度小于3毫米时，应避免使用磨头以避免主要组织损伤。
