Department of Orthopedic Oncology, Beijing Ji Shui Tan Hospital, No. 31 Xin jie kou Dong Jie, Xi Cheng District, Beijing 100035, China.
National University Hospital, Singapore.
Comput Math Methods Med. 2022 May 31;2022:7635945. doi: 10.1155/2022/7635945. eCollection 2022.
Symptomatic osteochondroma of the proximal femur necessitates a surgical excision. The purpose of this study was to describe a novel technique of computer navigation-aided excision for osteochondromata of the proximal femur. Outcomes of this technique are also presented.
A total of 13 patients underwent computer navigation-aided excision of osteochondromata of the proximal femur from February 2012 to August 2016 in our institution. They were enrolled in this study. OrthoMap 3D (Stryker Orthopaedics, Mahwah, NJ, USA), a commercially available navigation software system, was used to merge computed tomography images of the proximal femur with an osteochondromata with the image of a normal proximal femur. Using the normal proximal femur as a template, intended resection margins for the proximal femur with osteochondromata were planned and then executed using intraoperative navigation guidance. Patients were followed up clinically and radiographically. The physical and mental health of patients was assessed with the Musculoskeletal Tumor Society (MSTS) score.
Eight patients had isolated exostoses. Five patients had tumors associated with multiple hereditary exostoses. For tumors projecting posteriorly or posteromedially, a posterolateral approach was used. For tumors projecting anteriorly or medially, an anterior approach was used. Prophylactic fixation was performed in four patients who required an anterior approach. The mean duration of the surgery was 189 minutes. There were no intraoperative fractures or postoperative complications. A secondary procedure was not needed for any case. The mean MSTS score at a mean follow-up of 17 months was 28.6 (maximum MSTS score: 30).
This is the first study to report a novel application of computer navigation for aiding the excision of osteochondromata of the proximal femur. It demonstrated favorable postoperative functional scores with a low rate of complications. The applicability, safety, and efficacy of this technique were demonstrated. It is particularly useful for resections involving large tumors that can obscure anatomical landmarks and for patients with associated proximal femoral deformity.
股骨近端症状性软骨瘤需要手术切除。本研究旨在描述一种新的计算机导航辅助股骨近端软骨瘤切除术的技术。并介绍该技术的结果。
自 2012 年 2 月至 2016 年 8 月，我院共对 13 例股骨近端软骨瘤患者行计算机导航辅助切除术。使用 OrthoMap 3D（Stryker Orthopaedics，Mahwah，NJ，USA）商业导航软件系统，将股骨近端 CT 图像与软骨瘤融合到正常股骨近端图像中。利用正常股骨近端作为模板，规划股骨近端带有软骨瘤的预期切除边界，然后在术中导航引导下进行切除。对患者进行临床和影像学随访。采用肌肉骨骼肿瘤学会（MSTS）评分评估患者的身心健康。
8 例患者为孤立性外生骨疣。5 例患者为多发性遗传性外生骨疣伴发肿瘤。对于向后或后内侧突出的肿瘤，采用后外侧入路；对于向前或向内侧突出的肿瘤，采用前侧入路。4 例需要前入路的患者预防性固定。手术平均持续时间为 189 分钟。术中无骨折，术后无并发症。没有病例需要二次手术。17 个月的平均随访中，平均 MSTS 评分为 28.6（最高 MSTS 评分为 30）。
这是第一项报告计算机导航在辅助股骨近端软骨瘤切除中应用的研究。该研究显示术后功能评分良好，并发症发生率低。证明了该技术的适用性、安全性和有效性。对于涉及较大肿瘤、可能掩盖解剖标志的切除，以及合并股骨近端畸形的患者，该技术特别有用。
