Zhang Yaqing, Wen Lianjiang, Zhang Jun, Yan Guoliang, Zhou Yue, Huang Bo
Department of Orthopedics, Xinqiao Hospital, The Third Military Medical University, Chongqing, China.
Medicine (Baltimore). 2017 Mar;96(12):e6414. doi: 10.1097/MD.0000000000006414.
Three-dimensional (3D) printed templates can be designed to match an individual's anatomy, allowing surgeons to refine preoperative planning. In addition, the use of computer navigation (NAV) is gaining popularity to improve surgical accuracy in the resection of pelvic tumors. However, its use in combination with 3D printing to assist complex pelvic tumor resection has not been reported.
A 36-year-old man presented with left-sided pelvic pain and a fast-growing mass. He also complained of a 3-month history of radiating pain and numbness in the lower left extremity.
A biopsy revealed an osteochondroma with malignant potential. This osteochondroma arises from the ilium and involves the sacrum and lower lumbar vertebrae.
Here, we describe a novel combined application of 3D printing and intraoperative NAV systems to guide hemipelvectomy for en-bloc resection of the osteochondroma. The 3D printed template is analyzed during surgical planning and guides the initial intraoperative bone work to improve surgical accuracy and efficiency, while a computer NAV system provides real-time imaging during the tumor removal to achieve adequate resection margins and minimize the likelihood of injury to adjacent critical structures.
The tumor mass and the invaded spinal structures were removed en bloc.
The combined application of 3D printing and computer NAV may be useful for tumor targeting and safe osteotomies in pelvic tumor surgery.
三维（3D）打印模板可设计成与个体解剖结构相匹配，使外科医生能够优化术前规划。此外，计算机导航（NAV）的应用越来越广泛，以提高盆腔肿瘤切除手术的准确性。然而，其与3D打印联合用于辅助复杂盆腔肿瘤切除的情况尚未见报道。
一名36岁男性，出现左侧盆腔疼痛和一个快速生长的肿块。他还主诉有3个月左侧下肢放射性疼痛和麻木的病史。
活检显示为具有恶性潜能的骨软骨瘤。该骨软骨瘤起源于髂骨，累及骶骨和下腰椎。
在此，我们描述了一种3D打印和术中NAV系统的新型联合应用，以指导半骨盆切除术，整块切除骨软骨瘤。在手术规划过程中分析3D打印模板，并指导术中初始的骨操作，以提高手术准确性和效率，而计算机NAV系统在肿瘤切除过程中提供实时成像，以实现足够的切除边缘，并将损伤相邻关键结构的可能性降至最低。
肿瘤肿块和受侵犯的脊柱结构被整块切除。
3D打印和计算机NAV的联合应用可能有助于盆腔肿瘤手术中的肿瘤靶向定位和安全截骨。
