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首页> 外文期刊>Sarcoma >A Cadaveric Comparative Study on the Surgical Accuracy of Freehand, Computer Navigation, and Patient-Specific Instruments in Joint-Preserving Bone Tumor Resections
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A Cadaveric Comparative Study on the Surgical Accuracy of Freehand, Computer Navigation, and Patient-Specific Instruments in Joint-Preserving Bone Tumor Resections

机译：一种尸体比较研究，对骨肿瘤切除术中的手绘，计算机导航和特定患者特异性仪器的手术准确性

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摘要

Orthopedic oncologic surgery requires preservation of a functioning limb at the essence of achieving safe margins. With most bone sarcomas arising from the metaphyseal region, in close proximity to joints, joint-salvage surgery can be challenging. Intraoperative guidance techniques like computer-assisted surgery (CAS) and patient-specific instrumentation (PSI) could assist in achieving higher surgical accuracy. This study investigates the surgical accuracy of freehand, CAS- and PSI-assisted joint-preserving tumor resections and tests whether integration of CAS with PSI (CAS?+?PSI) can further improve accuracy. CT scans of 16 simulated tumors around the knee in four human cadavers were performed and imported into engineering software (MIMICS) for 3D planning of multiplanar joint-preserving resections. The planned resections were transferred to the navigation system and/or used for PSI design. Location accuracy (LA), entry and exit points of all 56 planes, and resection time were measured by postprocedural CT. Both CAS?+?PSI- and PSI-assisted techniques could reproduce planned resections with a mean LA of less than 2?mm. There was no statistical difference in LA between CAS + PSI and PSI resections (p=0.92), but both CAS + PSI and PSI showed a significantly higher LA compared to CAS (p=0.042 and p=0.034, respectively). PSI-assisted resections were faster compared to CAS?+?PSI (p<0.001) and CAS (p<0.001). Adding CAS to PSI did improve the exit points, however not significantly. In conclusion, PSI showed the best overall surgical accuracy and is fastest and easy to use. CAS could be used as an intraoperative quality control tool for PSI, and integration of CAS with PSI is possible but did not improve surgical accuracy. Both CAS and PSI seem complementary in improving surgical accuracy and are not mutually exclusive. Image-based techniques like CAS and PSI are superior over freehand resection. Surgeons should choose the technique most suitable based on the patient and tumor specifics.
机译：骨科肿瘤手术需要在实现安全边缘的本质上保存一个功能肢体。随着复属地区的大多数骨骼肉瘤，紧邻关节，关节抢救手术可能具有挑战性。术中指导技术如计算机辅助手术（CAS）和患者特定的仪器（PSI）可以帮助实现更高的手术精度。本研究调查了手绘，CAS和PSI辅助的关节保存肿瘤切除的手术精度，并测试CA与PSI（CAS？+ + PSI）的整合是否可以进一步提高精度。在四个人尸体周围膝盖周围的16种模拟肿瘤的CT扫描进行，并进口到了用于多平板环保切除的3D规划的工程软件（模仿）。计划的切除转移到导航系统和/或用于PSI设计。定位精度（LA），所有56个平面的入口和出口点，并通过后预先形成CT测量切除时间。 CAS？+ + PSI和PSI和PSI辅助技术可以再现计划切除的平均La小于2Ωmm。 CAS + PSI和PSI切除术之间的LA统计学差异（P = 0.92），但与CAS（P = 0.042和P = 0.034）相比，CAS + PSI和PSI两者均显示出明显高的LA。与CAS + + + PSI（P <0.001）和CAS（P <0.001）相比，PSI辅助切除速度更快。添加CA到PSI确实改善了出口点，但没有显着。总之，PSI显示出最佳的整体手术精度，最快，易于使用。 CAS可用作PSI的术中质量控制工具，并且CA与PSI的集成是可能的，但没有提高手术精度。 CAS和PSI似乎在提高外科精度方面互补，并且不相互排斥。基于图像的基础技术，如CAS和PSI优越在徒手徒步切除方面。外科医生应根据患者和肿瘤细节选择最适合的技术。

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