National Unit of Orthopaedic Oncology, Tel Aviv Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
Int J Comput Assist Radiol Surg. 2021 Apr;16(4):695-701. doi: 10.1007/s11548-021-02337-w. Epub 2021 Mar 16.
Several technologies have been implemented in orthopedic surgery to improve surgical outcomes, usually focusing on more accurate execution of a surgical plan, but the development of the plan itself is also of great importance. The purpose of this study is to examine whether the use of preoperative computer planning platforms can improve the surgical plan?
Eight surgeons created a preoperative surgical plan to resect a distal femur parosteal osteosarcoma in two settings: (1) Using a 2-D and 3-D CT scan only (current standard); and (2) using a computer-assisted planning platform. The plans were thereafter virtually executed using a novel surgical navigation system and a Sawbones model. This simulated model was derived from, and identical to, an actual patient scenario. The outcomes of interest were the number of positive margin cuts, and the volume of the resected specimen.
Using the surgical plan developed with computer assistance, there were 4 positive margin cuts made by 2 surgeons. In comparison, using standard planning, there were 14 positive margin cuts made by all 8 surgeons (p = 0.02). The resection volume was larger in the computer-assisted plans (96 ± 10 mm) than in the standard plans (88 ± 7 mm) (p = 0.055).
Computer-assisted planning significantly decreased the risk of a positive margin resection in this Sawbones tumor model used to simulate resection of a primary bone sarcoma. This proof of concept study highlights the importance of advanced surgical planning and sets the ground for developing beneficial surgical planning systems.
矫形外科领域已经采用了多种技术来改善手术结果，这些技术通常侧重于更准确地执行手术计划，但手术计划本身的制定也非常重要。本研究旨在探讨术前计算机规划平台的使用是否可以改善手术计划？
8 名外科医生在两种情况下制定了切除股骨远端骨旁骨肉瘤的术前手术计划：（1）仅使用二维和三维 CT 扫描（目前的标准）；（2）使用计算机辅助规划平台。然后，使用新型手术导航系统和 Sawbones 模型虚拟执行这些计划。该模拟模型源自实际患者情况且与之相同。感兴趣的结果是阳性切缘的数量和切除标本的体积。
使用计算机辅助制定的手术计划，有 2 名外科医生进行了 4 次阳性切缘。相比之下，使用标准计划，8 名外科医生共进行了 14 次阳性切缘（p=0.02）。计算机辅助计划的切除体积更大（96±10mm），而标准计划的切除体积更小（88±7mm）（p=0.055）。
在用于模拟原发性骨肉瘤切除的 Sawbones 肿瘤模型中，计算机辅助规划显著降低了阳性切缘切除的风险。这项概念验证研究强调了先进手术规划的重要性，并为开发有益的手术规划系统奠定了基础。
