Bederman S Samuel, Lopez Gregory, Ji Tao, Hoang Bang H
*Department of Orthopaedic Surgery, University of California Irvine, Irvine, CA †Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing, China; and ‡Department of Orthopaedic Surgery, Montefiore/Albert Einstein College of Medicine, Bronx, NY.
Spine (Phila Pa 1976). 2014 Nov 1;39(23):E1398-401. doi: 10.1097/BRS.0000000000000575.
Case report of a patient with primary osteosarcoma of the sacrum who underwent en bloc sacrectomy.
To describe a novel approach using robotic guidance for sacral tumor resection.
En bloc sacrectomy for aggressive primary malignancies or metastatic tumors of the sacrum can be technically challenging. Although imaging can delineate appropriately planned resection margins, the complex anatomy of the spinopelvic junction poses a challenge for the exact intraoperative execution of the preoperative plan.
The patient was a 22-year-old male who was diagnosed with a primary sacral osteosarcoma. The mass extended to the left sacroiliac joint requiring a transiliac osteotomy. Preoperative robotic-guidance software was used allowing for virtual planning of the transiliac osteotomy.
During surgery, the robot was attached and synchronized with the preoperative imaging. Pilot holes were drilled along the planned iliac resection margin. With rigid tubes placed in the left iliac pilot holes, we passed a series of osteotomes parallel to the tubes to the same depth as our drillings and completed our left iliac osteotomy. Negative tumor margins were achieved and the postoperative course was uneventful.
We report the first case of robotic-guided en bloc transiliac resection of a primary sacral osteosarcoma with extension to the sacroiliac joint. Robotic guidance for tumor resection can be a useful tool in such challenging surgical procedures to fully resect the tumor, while minimizing disruption of the surrounding healthy anatomy.
对一名接受整块骶骨切除术的原发性骶骨骨肉瘤患者的病例报告。
描述一种使用机器人引导进行骶骨肿瘤切除术的新方法。
对骶骨侵袭性原发性恶性肿瘤或转移性肿瘤进行整块骶骨切除术在技术上具有挑战性。尽管影像学可以勾勒出规划合理的切除边缘，但脊柱骨盆交界处复杂的解剖结构对术前计划在术中的精确实施构成了挑战。
患者为一名22岁男性，被诊断为原发性骶骨骨肉瘤。肿块延伸至左骶髂关节，需要进行经髂骨截骨术。使用术前机器人引导软件对经髂骨截骨术进行虚拟规划。
手术过程中，将机器人与术前影像连接并同步。沿着规划的髂骨切除边缘钻引导孔。在左髂骨引导孔中放置刚性管后，我们将一系列骨凿平行于管子插入到与钻孔相同的深度，完成了左髂骨截骨术。实现了肿瘤切缘阴性，术后病程平稳。
我们报告了首例机器人引导下对延伸至骶髂关节的原发性骶骨骨肉瘤进行整块经髂骨切除的病例。在这种具有挑战性的手术中，机器人引导肿瘤切除可成为一种有用的工具，既能完全切除肿瘤，又能最大限度减少对周围健康解剖结构的破坏。
5级。
