Kurisunkal V, Botchu R, Davies A M, James S L, Jeys L
Department of Orthopaedic Oncology Royal Orthopaedic Hospital, Birmingham, UK.
Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK.
J Orthop. 2020 May 1;22:268-273. doi: 10.1016/j.jor.2020.04.013. eCollection 2020 Nov-Dec.
Success in the management of bone sarcomas entails being able to achieve wide margins, which helps decrease the risk of local recurrence and provide an improvement in overall survival. The role of computer-assisted surgery has been investigated across various areas of orthopaedics, including joint replacement, cruciate ligament reconstruction, and pedicle screw placements which has led to increased interested in computer assisted tumour surgery (CATS). CATS can be used in a wide array of tumour surgeries, however its role in pelvic and sacral tumours is unparalled. Its importance lies in being able to provide radiological information to guide the surgeon at the time of surgery i.e. the distance from the tumour to the resection margin can be determined precisely based on preoperative planning and intra-operative image guidance. This minimises unnecessary bone resection, aiming to achieve good oncological and functional results which can be challenging in pelvic surgery. Most published articles on CATS have concentrated on the surgical aspects of navigation surgery. Although advanced imaging techniques such as magnetic resonance imaging (MRI) and computed tomography (CT) scans can provide anatomic detail about the primary tumour, the successful transfer of that information from a viewing screen to the intraoperative field can be difficult. The role of the radiologist lies in being able to provide appropriate imaging (CT, MRI) to facilitate surgical planning. This article aims at providing the radiologist a surgical insight on CATS and to facilitate optimal imaging in a patient tentatively being planned for CATS.
骨肉瘤治疗的成功需要能够实现广泛的切缘,这有助于降低局部复发风险并提高总生存率。计算机辅助手术在骨科的各个领域都得到了研究,包括关节置换、交叉韧带重建和椎弓根螺钉置入,这引发了人们对计算机辅助肿瘤手术(CATS)的更多兴趣。CATS可用于多种肿瘤手术,但其在盆腔和骶骨肿瘤中的作用无与伦比。其重要性在于能够在手术时提供放射学信息以指导外科医生,即根据术前规划和术中图像引导可以精确确定肿瘤与切除边缘的距离。这将不必要的骨切除降至最低,旨在实现良好的肿瘤学和功能结果,而这在盆腔手术中可能具有挑战性。大多数关于CATS的已发表文章都集中在导航手术的外科方面。尽管先进的成像技术如磁共振成像(MRI)和计算机断层扫描(CT)扫描可以提供有关原发性肿瘤的解剖细节,但将这些信息从观察屏幕成功转移到手术视野可能很困难。放射科医生的作用在于能够提供适当的成像(CT、MRI)以促进手术规划。本文旨在为放射科医生提供关于CATS的外科见解,并促进为初步计划进行CATS的患者进行最佳成像。