Computer-aided Primary Bone Tumor Surgery With Personalized Surgical Design

ObjectiveThrough computer aided design (CAD),computer aided manufacture (CAD), incremental production technology (RP),reverse engineering (RE), such as digital technology, the computer aided primary bone tumors accurate resection and reconstruction of large bone defect repair, function method, computer aided technology treatment of bone tumors and the clinical value of large bone defect.Methodsretrospective study application of computer-aided technology is precise in bone tumor resection and postoperative cases of long bone defect reconstruction, including 7 cases of malignant tumors of the sacrum,8 cases of benign bone tumors of femur,11 cases of malignant bone tumors around the knee joint. All cases preoperatively by CT or MRI scanning to obtain the tumor and its surrounding tissues of two-dimensional image data, import Mimics10.01 software to reconstruct 3D bone model, and 3D model of tumor invasion or infiltration;And according to the nature of the tumor by using Imageware software 3D matching, then analysis to determine bone tumor surgical resection border;Preoperative used Imageware and UG-NX software to design personalized surgery assisted template, and used the digital simulation of bone tumor resection and reconstruction process;According to the preoperative preset program, bone tumor resection and reconstruction of large bone defect were guided by precise surgery assisted template implementation.SPSS 16.0 software for statistical processing Measurement data were showed by the average (x±s), statsticed by two independent samples t test,and P<0.05 for statistically significant;Count data were statsticed by Fisher’s exact probability method, and P<0.05 for statistically significant.Results:1.7 cases of sacral tumors are adopt twin rod lumbar vertebra pelvis fixed, operation time ranged from 255-640 min, and average was 475.86±119.91 min. intraoperative hemorrhage rangeg from 2000 to 7000 ml, and average was 4725±1561.82 ml. Main complications:1 case of urine can’t control and loss of sexual function; 1 case was not restore sexual function and postoperative wound deep infection; 1 case caused by carelessly fixation rod fracture; 1 case of sacral chordoma postoperative recurrence after 3 years.2.8 cases of femoral tumor in the upper line of large allograft±internal fixation of hip revascularization. intraoperative bleeding intraoperative bleeding in 400-2000 ml, an average of 1181.21±721.08 ml. Follow-up of 12 to 38 months, the last follow-up records:8 cases of tumor recurrence was not found, no significant complications, average MSTS score 27.75±2.87 points, including excellent in 7 cases, good in 1 case.3.11 cases of computer aided technology to treat tumors around the knee joint compared with 14 cases of conventional surgery:1. Two groups of surgical patients’age, gender, preoperative pain score (VAS score) had no statistical significance (p>0.05).2. The intraoperative tumor resection in length and surgical blood loss had no statistical difference (p>0.05).3. The postoperative recurrence rate of CAD surgery group was 9.09%, while the traditional surgery group was 14.28%;Complications of CAD was 18.18%, while traditional surgery group was 18.18%;By Fisher’s exact probability method test (P>0.05), it can not prove that two kinds of operation method different in 1 year recurrence rate and complication.4. the last follow-up MSTS score of CAD group were 23-30 points, including excellent in 9 cases, good in 2 cases, and average of 27.36±2.42 points;Traditional group was 17-28 points (excluding 1 amputation cases,13 cases include), including excellent in 10 cases, good in 2 cases and medium in 2 cases, and average of 24.23±3.75 points, there are significant difference by using two independent samples t test statistical analysis(t=2.379, p< 0.05). Compared two groups of knee flexion mobility, CAD scores of knee joint was 80-120° active flexion mobility, an average of 114.55±2.93°;Traditional treatment knee joint initiative to 70-120° of flexion mobility(excluding 1 amputation cases,13 cases included in the statistics), an average of 102.31±12.18°.there are significant difference by using two independent samples t test statistical analysis(t=2.385, p<0.05).Conclusion:By Computer aided technology, Bone tumor can be resected accurately and kept the largest scope of normal bone,and large bone defect and joint function can be personalized of reconstruction.Computer aided technology compared with the traditional surgery has clear significant advantages.