Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhizaoju Road, Huangpu District, Shanghai, P.R. China.
Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhizaoju Road, Huangpu District, Shanghai, P.R. China.
Langenbecks Arch Surg. 2024 Nov 30;409(1):367. doi: 10.1007/s00423-024-03552-0.
The treatment of pelvic tumors has been widely recognized as challenging. Patient-specific osteotomy templates were designed and generated for precise surgery, based on tumor fusion images and 3D printing technology. This study aimed to investigate the accuracy of patient-specific osteotomy templates for the resection of pelvic tumors.
From April 2014 to August 2023, 27 patients with pelvic tumors at our hospital were enrolled in this study. All patients underwent CT and enhanced MRI before surgery to develop a 3D preoperative imaging plan model for pelvic tumors based on tumor fusion images. For patients in the intraoperative use of osteotomy templates group, we designed and generated patient-specific osteotomy templates for intraoperative assisted tumor resection. For patients in the no use of osteotomy templates group, surgeons performed tumor resection according to conventional techniques. All patients were followed up to obtain postoperative CT images of the pelvis. Preoperative planning osteotomy surface and intraoperative actual osteotomy surface were obtained by means of the image registration technique. Then, the distance deviation and angle deviation between the two surfaces were compared to assess the accuracy of surgery.
Surgery was successfully completed in 27 patients, and all specimens were obtained for tumor-free resection margins. The median of intraoperative bleeding was 2350(1425 ∼ 3000) ml in the intraoperative use of osteotomy templates group and 4500(3150 ∼ 5200)ml in the no use of osteotomy templates group. p-value was 0.016. The median angular deviation of the actual osteotomy surfaces from the planned osteotomy surfaces was 5.02 (2.84 ∼ 7.37)° in the intraoperative use of osteotomy templates group, and 7.17 (4.49 ∼ 11.96)° in the no use of osteotomy templates group. p-value was 0.044. The absolute mean distance deviation between the two surfaces was 4.90 ± 3.01 mm in the intraoperative use of osteotomy templates group, and 7.21 ± 3.89 mm in the no use of osteotomy templates group. p-value was 0.038.
3D-printed patient-specific osteotomy templates can be accurately customized based on preoperative tumor fusion image, which can help improve the precision of pelvic tumor surgery.
骨盆肿瘤的治疗一直被广泛认为具有挑战性。本研究旨在探讨基于肿瘤融合图像和 3D 打印技术设计和生成的个体化截骨模板在骨盆肿瘤切除术中的准确性。基于肿瘤融合图像，我们设计并生成了个体化截骨模板，用于精确手术。
2014 年 4 月至 2023 年 8 月，我院收治 27 例骨盆肿瘤患者。所有患者术前均行 CT 和增强 MRI 检查，根据肿瘤融合图像制定骨盆肿瘤的 3D 术前影像学计划模型。对于术中使用截骨模板组的患者，我们为术中辅助肿瘤切除设计并生成了个体化截骨模板。对于不使用截骨模板组的患者，外科医生根据传统技术进行肿瘤切除。所有患者均进行随访，获得骨盆术后 CT 图像。通过图像配准技术获得术前规划截骨面和术中实际截骨面。然后，比较两表面之间的距离偏差和角度偏差，以评估手术的准确性。
27 例患者手术均顺利完成，均获得无肿瘤切缘的标本。术中使用截骨模板组的术中出血量中位数为 2350(1425～3000)ml，不使用截骨模板组为 4500(3150～5200)ml，p 值为 0.016。术中使用截骨模板组实际截骨面与规划截骨面的角度偏差中位数为 5.02(2.84～7.37)°，不使用截骨模板组为 7.17(4.49～11.96)°，p 值为 0.044。术中使用截骨模板组两表面之间的绝对平均距离偏差为 4.90±3.01mm，不使用截骨模板组为 7.21±3.89mm，p 值为 0.038。
基于术前肿瘤融合图像，可精确定制 3D 打印的个体化截骨模板，有助于提高骨盆肿瘤手术的精确性。
