3D打印髋臼导板辅助的骨盆肿瘤切除后精确性分析

摘要

目的:分析3D打印技术在术前骨盆恶性肿瘤手术模拟与规划、术中切除、术后切除效果分析的应用及意义.方法:回顾性分析2014年11月至2018年11月在新疆医科大学第一附属医院收治的20例骨盆原发性恶性肿瘤患者的临床资料,其中男性11例,女性9例;平均年龄39.1(14～60)岁.骨肉瘤7例、软骨肉瘤12例、尤文肉瘤1例.参照Enneking骨盆分区,累及骨盆Ⅱ区和Ⅲ区6例,Ⅰ区和Ⅱ区6例,Ⅰ区和Ⅳ区8例.按是否采用3D打印截骨导板分为3D打印导板组(试验组)10例及常规组(对照组) 10例,比较两组手术时间、出血量、功能评分、线性距离等情况.结果:20例患者手术顺利完成,获得整块切除;试验组手术时间(4.4±1.4)h,与对照组(4.5±1.4)h比较差异无统计学意义(P=0.83);试验组术中出血量(1980±1158)mL,与对照组(2785±1784)mL比较差异无统计学意义(P=0.16);试验组线性差距平均(3.8±1.9)cm,与对照组(8.7±1.0)cm比较差异有统计学意义(P=0.001).结论:试验组可指导术中精确截骨,方便操作,简化手术具有推广应用价值;精确度方面优于对照组.%Objective: To analyze the application and significance of three-dimensional (3D) printing in the surgical simulation and plan-ning for pelvic malignant tumors before the actual surgery, surgical resection, and postoperative resection effect analysis. Methods: A retrospective analysis was performed for 20 cases of primary pelvic malignant tumors in 11 male and 9 female patients with a mean age of 39.1 years (range, 14-60 years) who were admitted to Xinjiang University of Medical Science and Technology between January 2014 and January 2018. The tumors included osteosarcoma in 7 patients, chondrosarcoma in 12, and Ewing's sarcoma in one. Accord-ing to the Enneking pelvic classification, 10 cases involved the pelvicⅡarea; 6, the pelvicⅢarea; 6, the pelvicⅠandⅡareas; and 8, the pelvic I andⅣareas. According to whether or not a 3D-printed osteotomy guide plate was used, the cases were divided into a 3D-printed guide plate group and a conventional group, with 10 cases in each group. Operation time, blood loss volume, function score, and linear distance deviation were compared between the two groups. Results: The operation was completed successfully with com-plete excision in 20 patients. The operation time in the 3D-printed guide plate group (4.4～1.4 h) was not statistically significantly dif-ferent from that in the control group (4.5～1.4 h; P=0.83). No significant difference in intraoperative blood loss volume was found be-tween the 3D-printed guide plate (1,980～1,158 mL) and control (2,785～1,784 mL; P=0.16) groups. The postoperative Musculoskele-tal Tumor Society score (20.4～0.98) in the 3D-printed guide plate group showed no significant difference from that in the convention-al group (20.2～1.29; P=0.78). The mean linear difference between the 3D-printed guide plate group (3.8～1.9 cm) and the conven-tional group (8.7～1.0) was statistically significant (P=0.001). Conclusions: The 3D-printed group was not significantly different from the conventional group in terms of operation time, blood loss volume, and function score but had better surgical resection accuracy than the conventional group.