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基于计算机断层扫描的导航系统辅助下的原发性脊柱肿瘤手术

Computed tomography-based navigation system-assisted surgery for primary spine tumor.

作者信息

Ando Kei, Kobayashi Kazuyoshi, Machino Masaaki, Ota Kyotaro, Morozumi Masayoshi, Tanaka Satoshi, Ishiguro Naoki, Imagama Shiro

机构信息

Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan.

Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan.

出版信息

J Clin Neurosci. 2019 May;63:22-26. doi: 10.1016/j.jocn.2019.02.015. Epub 2019 Feb 28.

Abstract

Primary tumors of the spine are uncommon compared to metastases. The objective of the study was to examine the utility of O-arm navigation-assisted surgery for a primary spine tumor. A prospective study was performed in 18 consecutive patients who underwent O-arm navigation-assisted surgery for a primary spine tumor at our hospital between 2014 and 2017. Data were collected for patient demographics, tumor details, surgery performed, and postoperative complications. The proportion of patients with a primary spine tumor; complications in the navigation procedure and equipment; complications in resection; local recurrence; radiological evidence of mechanical failure in cases where implants were used for reconstruction; and mortality were evaluated as outcomes. The cases included osteoblastoma (n = 4), Langerhans cell histiocytosis (n = 3), aneurysmal bone cyst (ABC), chondrosarcoma, osteoid osteoma (n = 2 each), and giant cell tumor (GCT), pigmented villonodular synovitis (PVNS), hemangioma, sarcoidosis, and plasmacytoma (n = 1 each). There were no intraoperative complications related to the navigation procedure or equipment, and this procedure was not abandoned after it had been started in any case. There were 12 posterior, 3 anterior, and 3 posterior and anterior approaches, and 7 instrumented surgeries. There was no evidence of screw misplacement and mechanical implant failure, and no local recurrence in any patients. O-arm navigation-assisted surgery improves safety and oncological results in patients with primary spine tumors. The beneficial effects of navigation for resection of tumors include more accurate placement of screws with fewer complications.

摘要

与脊柱转移瘤相比,原发性脊柱肿瘤并不常见。本研究的目的是探讨O型臂导航辅助手术在原发性脊柱肿瘤治疗中的应用价值。对2014年至2017年间在我院接受O型臂导航辅助手术治疗原发性脊柱肿瘤的18例连续患者进行了一项前瞻性研究。收集了患者的人口统计学数据、肿瘤详细信息、手术情况及术后并发症等资料。评估原发性脊柱肿瘤患者的比例;导航过程及设备相关并发症;切除相关并发症;局部复发情况;使用植入物进行重建的病例中机械性失败的影像学证据;以及死亡率等作为研究结果。病例包括骨母细胞瘤(n = 4)、朗格汉斯细胞组织细胞增多症(n = 3)、动脉瘤样骨囊肿(ABC)、软骨肉瘤、骨样骨瘤(各n = 2)、巨细胞瘤(GCT)、色素沉着绒毛结节性滑膜炎(PVNS)、血管瘤、结节病和浆细胞瘤(各n = 1)。未发生与导航过程或设备相关的术中并发症,且在任何情况下手术开始后均未放弃该手术。采用后路手术12例、前路手术3例、前后联合手术3例,7例进行了内固定手术。未发现螺钉位置不当及机械性植入物失败的证据,所有患者均未出现局部复发。O型臂导航辅助手术可提高原发性脊柱肿瘤患者的安全性及肿瘤学治疗效果。导航辅助肿瘤切除的有益效果包括螺钉置入更准确且并发症更少。

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