1Department of Orthopedics, Guizhou Province Orthopedic Hospital, Guiyang 550000, China; 2Department of Bone and Soft Tissue Tumor Surgery, Liaoning Cancer Hospital & Institute, Shenyang 110042, China
Abstract：Objective This study aims to explore the clinical application value of the mixed realistic surgery in the precise surgical treatment of the bone tumor. Methods The clinical data of 14 patients with bone tumor (7 males and 7 females, average age=32 years) who met the inclusion criteria from September 2018 to March 2019 were retrospectively analyzed. Among the tumor sites, 4 cases of distal femur, 3 cases of proximal tibia, 3 cases of scapula, 2 cases of pelvis, 1 case in proximal humerus, and 1 case in proximal clavicle, were observed. Eleven cases of malignant tumors, including 6 cases of osteosarcoma, 2 cases of chondrosarcoma, 1 case of rhabdomyosarcoma, 2 cases of metastatic carcinoma. Three cases of benign tumors, including 1 case of giant cell tumor of bone, 1 case of osteoblastoma, and 1 case of eosinophilic granuloma, were observed. Before the surgery, all patients were preoperatively treated using a 640-slice spiral CT scanner for enhanced 3D reconstruction of the tumor site, and the original CT DICOM data of the patients were collected, which were imported into the 3D medical imaging workstation for segmentation, reconstruction, and material setting. Holographic image data were obtained through the “star map” mixed realistic imaging system. The preoperative hologram was used to make a personalized surgical plan, and general anesthesia was used during the operation. The operation was completed in accordance with the preoperative plan. The operative time, intraoperative blood loss, postoperative complications, and safe surgical boundary of tumor were observed. The limb length of the lower limbs before and after prosthesis replacement was determined. The function of the affected limb was evaluated in the final follow-up by using the Musculoskeletal Tumor Society (MSTS) 93 scoring standard. Results In this group, 14 patients were guided by the mixed reality technology for the accurate localization and the complete resection of tumor tissue. In six patients undergoing knee tumor prosthesis replacement, the preoperative measurement of the length difference of the lower limbs was 1.3-6.5 (3.70±1.87) mm, and the postoperative measurement of the length difference of the lower limbs was 1.7-4.9 (2.95±1.24) mm. No significant difference was observed in the length between the two lower limbs before and after the operation (t=0.672, P>0.05). The MR examination or the CT scan was performed three days after surgery to evaluate the surgical boundary. The tumor was completely removed, and the internal fixator was in good position. All 14 patients were followed up for 15-20 months (average=16 months). The MSTS score at the last follow-up was 17-28 points (average=23.9 points). The function of affected limb was excellent in seven cases and good in seven cases. During the follow-up period, none of the 14 patients died, and no tumor recurrence or metastasis was observed. Conclusions The stereoscopic and the comprehensive anatomical details of the lesion site provided by the mixed reality technology can assist the preoperative surgical planning; improve the accuracy, safety, and effectiveness of the intraoperative tumor resection; and realize the visualization and the individualization of the surgical planning of bone tumor and may be clinically promoted.
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Gao Yuan, Pan Feng, Zhang Jun, Qiu Enduo, Xia Tienan, Tang Bensen, Qiu Bing, Shang Guanning. Application value of the mixed reality technique in the precision surgery of bone and the soft tissue malignant tumor. Chinese Journal of Anatomy and Clinics, 2021, 26(2): 162-167.
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2021, Vol. 26 
