三维可视化技术在脊柱颈胸段原发性肿瘤手术治疗中的应用

doi:10.3760/cma.j.cn101202-20221002-00296

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (8068 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探讨三维可视化技术在脊柱颈胸段原发性肿瘤手术治疗中的临床应用价值。方法病例系列报告。纳入2019年6月—2021年6月新疆维吾尔自治区人民医院脊柱外科手术治疗的颈胸段原发性脊柱肿瘤患者2例。病例1为男性,47岁,C_6、7椎体孤立性纤维瘤,术前有颈部疼痛及上肢放射痛症状,伴左侧肢体无力。病例2为女性,17岁,T₁椎体动脉瘤样骨囊肿,有颈肩痛症状,合并左上肢远端肌力下降。2例患者术前均接受CT扫描并使用Mimics软件建立三维可视化脊柱颈胸段模型,采用激光快速成型打印技术制作与实物1∶1大小的3D打印脊柱颈胸段模型,规划设计并定制3D打印人工椎体,分别用于术前评估肿瘤分期、制定个体化手术方案,以及术中指导置钉和脊柱序列重建。病例1采用前后联合入路,行前路C_6、7椎体切除、3D打印人工椎体置入+后路椎弓根螺钉内固定术;病例2采用单纯后入路,行胸椎肿瘤切除+3D打印人工椎体置入+椎弓根螺钉内固定术。观察患者手术时间、术中出血量、手术并发症情况,评估手术前后颈部及上肢疼痛视觉模拟评分法（VAS）评分和上肢肌力,随访期间观察肿瘤是否复发及脊柱稳定性。结果 2例患者均顺利完成颈胸段椎体肿瘤切除+脊柱重建手术。病例1手术时间6.5 h,术中出血量1 200 mL;病例2手术时间4.5 h,术中出血量1 000 mL。2例患者术后疼痛症状明显缓解、自觉肌力逐渐恢复正常。病例1术后第7天发现伤口处脑脊液漏,经穿刺抽液、加压包扎治愈;术后出现声音嘶哑,随访至3个月时好转。病例2未见术后并发症。2例患者术后均随访12个月。末次随访时见患者椎体及肢体功能良好,肿瘤无复发,脊柱稳定性良好。病例1术前左侧颈部和左上肢疼痛VAS评分分别为7分和5分,末次随访时分别为3分和0分;术前左侧上、下肢各肌肌力均有不同程度下降,末次随访时除左侧指伸肌肌力为Ⅳ级以外的其余各肌肌力均为Ⅴ级。病例2术前左侧颈部和左上肢疼痛VAS评分6分和3分,末次随访时分别为2分和0分;术前左上肢指伸肌和指屈肌肌力Ⅳ级,末次随访时均恢复至Ⅴ级。结论三维可视化技术是一种直观、动态、全面的影像学评估方法,结合3D打印技术,可在术前明确肿瘤分期、制定手术方案,术中指导手术置钉及脊柱序列重建,对于颈胸段椎体原发性肿瘤的手术治疗具有重要的临床价值。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章

关键词 ：脊椎肿瘤, 脊柱颈胸段, 图像处理, 计算机辅助, 三维可视化, 三维打印, 人工椎体

Key words： Spinal neoplasms Cervicothoracic junction spinal Image processing computer-assisted Three-dimensional visualization Three-dimensional printing Artificial vertebral body

收稿日期: 2022-10-02

基金资助:新疆“天池英才”引进计划

通讯作者: 王浩, Email：doctor_wanghao@sina.com

引用本文:

张树文, 沙西卡·那孜尔汗, 孙治国, 陆琳松, 王浩. 三维可视化技术在脊柱颈胸段原发性肿瘤手术治疗中的应用[J]. 中华解剖与临床杂志, 2023, 28(5): 338-344.
Zhang Shuwen, Shaxika Nazierhan, Sun Zhiguo, Lu Linsong, Wang Hao. Application value of three-dimensional visualization technology in the surgery of primary cervicothoracic junction spinal tumors. Chinese Journal of Anatomy and Clinics, 2023, 28(5): 338-344.

链接本文:

http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20221002-00296 或 http://www.cjac.com.cn/CN/Y2023/V28/I5/338

[1]	李建民, 李振峰. 中国脊柱肿瘤外科治疗存在问题及面临的挑战[J].中华骨科杂志,2018,38(10):577-579. DOI: 10.3760/cma.j.issn.0253-2352.2018.10.001
[2]	Kaya RA, Cavuşoğlu H, Tanik C, et al.Spinal cord compression caused by a brown tumor at the cervicothoracic junction[J]. Spine J, 2007,7(6):728-732. DOI: 10.1016/j.spinee.2006.07.013
[3]	Molina CA, Gokaslan ZL, Sciubba DM. Diagnosis and management of metastatic cervical spine tumors[J]. Orthop Clin North Am, 2012,43(1):75-87, viii-ix. DOI: 10.1016/j.ocl.2011.08.004
[4]	梁鹏, 梁福东, 齐江华. 脊柱转移瘤治疗进展[J].国际骨科学杂志,2021,42(04):201-204
[5]	Balestrino A, Gondar R, Jannelli G, et al.Surgical challenges in posterior cervicothoracic junction instrumentation[J]. Neurosurg Rev, 2021,44(6):3447-3458. DOI: 10.1007/s10143-021-01520-6
[6]	Godzik J, Dalton JF, Martinez-Del-Campo E, et al. Biomechanical evaluation of cervicothoracic junction fusion constructs[J]. World Neurosurg, 2018, Dec 20,S1878-8750(18)82863-8.DOI: 10.1016/j.wneu.2018.12.040.(published online ahead of print)
[7]	Joshi N, Klinger N, Halalmeh DR, et al.The neural sulcus of the cervical vertebrae: a review of its anatomy and surgical perspectives[J]. Cureus, 2020,12(1):e6693. DOI: 10.7759/cureus.6693
[8]	Wang S, Chen Z, Zhang K, et al.Individualized surgical treatment for patients with tumours of the cervicothoracic junction[J]. Interact Cardiovasc Thorac Surg, 2022,34(6):1024-1030. DOI: 10.1093/icvts/ivab297
[9]	Xiao JR, Huang WD, Yang XH, et al.En Bloc Resection of primary malignant bone tumor in the cervical spine based on 3-dimensional printing technology[J]. Orthop Surg, 2016,8(2):171-178. DOI: 10.1111/os.12234
[10]	Gibbs WN, Nael K, Doshi AH, et al.Spine oncology: imaging and intervention[J]. Radiol Clin North Am, 2019,57(2):377-395. DOI: 10.1016/j.rcl.2018.10.002
[11]	Cai H, Liu Z, Wei F, et al.3D Printing in spine surgery[J]. Adv Exp Med Biol, 2018,1093:345-359. DOI: 10.1007/978-981-13-1396-7_27
[12]	Sheha ED, Gandhi SD, Colman MW.3D printing in spine surgery[J]. Ann Transl Med, 2019,7(Suppl 5):S164. DOI: 10.21037/atm.2019.08.88
[13]	周国磊, 尤涛, 杨剑. 三维可视化与三维打印技术在结构性心脏病介入治疗中的应用[J].中华胸心血管外科杂志,2022,38(5):316-320. DOI: 10.3760/cma.j.cn112434-20200915-00421.Zhou GL, You T, Yang J.Application of 3D visualization and 3D printing technology in interventional therapy of structural heart disease[J]. Chin J Thorac and Cardiovasc Surg, 2022,38(5):316-320. DOI: 10.3760/cma.j.cn112434-20200915-00421
[14]	陈云, 周松, 李鑫, 等. 三维可视化手术规划系统在肝脏大血管瘤微波消融治疗中的价值[J].中华肝胆外科杂志,2019,25(12):890-893. DOI: 10.3760/cma.j.issn.1007-8118.2019.12.003.Chen Y, Zhou S, ,Li X, et al. A comparative study on the use of a three-dimensional visualization operative planning system in Ultrasound-guided percutaneous microwave ablation for large hepatic hemangiomas[J].Chin J Hepatobiliary Surg, 2019,25(12):890-893. DOI: 10.3760/cma.j.issn.1007-8118.2019.12.003
[15]	方驰华, 刘文瑛, 范应方, 等. 三维可视化技术指导经硬镜靶向碎石治疗肝胆管结石[J].中华外科杂志,2014,52(2):117-121. DOI: 10.3760/cma.j.issn.0529-5815.2014.02.009.Fang CH, Liu WY, Fan YF, et al.Applied rigid choledochoscope and pneumatic lithotripsy in targeting treatment of hepatolithiasis guided by three-dimensional visualization technology[J]. Chin J Surg, 2014,52(2):117-121. DOI: 10.3760/cma.j.issn.0529-5815.2014.02.009
[16]	Tomita K, Kawahara N, Murakami H, et al.Total en bloc spondylectomy for spinal tumors: improvement of the technique and its associated basic background[J]. J Orthop Sci, 2006,11(1):3-12. DOI: 10.1007/s00776-005-0964-y
[17]	Boriani S.En bloc resection in the spine: a procedure of surgical oncology[J]. J Spine Surg, 2018,4(3):668-676. DOI: 10.21037/jss.2018.09.02
[18]	Mazel C, Balabaud L, Bennis S, et al. Cervical and thoracic spine tumor management: surgical indications, techniques,outcomes[J]. Orthop Clin North Am, 2009,40(1):75-92, vi-vii. DOI: 10.1016/j.ocl.2008.09.008
[19]	Yadla S, Malone J, Campbell PG, et al.Incidence of early complications in cervical spine surgery and relation to preoperative diagnosis: a single-center prospective study[J]. J Spinal Disord Tech, 2011,24(1):50-54. DOI: 10.1097/BSD.0b013e3181d0d0e8
[20]	Placantonakis DG, Laufer I, Wang JC, et al.Posterior stabilization strategies following resection of cervicothoracic junction tumors: review of 90 consecutive cases[J]. J Neurosurg Spine, 2008,9(2):111-119. DOI: 10.3171/SPI/2008/9/8/111
[21]	Zeng JH, Zhong ZM, Chen JT.Early dysphagia complicating anterior cervical spine surgery: incidence and risk factors[J]. Arch Orthop Trauma Surg, 2013,133(8):1067-1071. DOI: 10.1007/s00402-013-1773-y
[22]	Ramamurti P, Weinreb J, Fassihi SC, et al. Vertebral artery injury in the cervical spine: anatomy, diagnosis,management[J]. JBJS Rev, 2021,9(1):e20.00118. DOI: 10.2106/JBJS.RVW.20.00118
[23]	王文军, 李耿, 王麓山, 等. 前路U形钛板在腰骶段脊柱肿瘤切除术后稳定性重建中的应用[J].中国脊柱脊髓杂志,2007,17(1):20-23. DOI: 10.3969/j.issn.1004-406X.2007.01.005.Wang WJ, Li G, Wang LS, et al.Application of anterior reconstruction with U-shape titanium-plate in lumbosacral tumor[J]. Chinese Journal of Spine and Spinal Cord, 2007,17(1):20-23. DOI: 10.3969/j.issn.1004-406X.2007.01.005
[24]	李家良, 闻志靖, 贺西京, 等. 可动型人工椎体的研究进展[J].中国骨伤,2019,32(7):677-682. DOI: 10.3969/j.issn.1003-0034.2019.07.017.Li, JL, Wen ZJ, He XJ, et al. Advances on the study of movable artificial vertebral body[J]. China Journal of Orthopaedics and Traumatology,2019,32(7):677-682. DOI: 10.3969/j.issn.1003-0034.2019.07.017
[25]	吴家昌, 李修往, 方国芳, 等. 3D打印人工椎体在脊柱肿瘤手术中的设计及初步应用[J].中华创伤骨科杂志,2020,22(10):855-861. DOI: 10.3760/cma.j.cn115530-20200819-00531.Wu JC, Li XW, Fang GF, et al.Design and preliminary application of 3D-printed vertebral bodies in spinal tumor surgery[J]. Chin J Orthop Trauma, 2020,22(10):855-861. DOI: 10.3760/cma.j.cn115530-20200819-00531
[26]	石磊, 栗向东, 李小康, 等. 新型3D打印个体化人工椎体在脊柱重建中的初步研究[J].中华骨科杂志,2020,40(6):335-343. DOI: 10.3760/cma.j.cn121113-20200303-00128.He L, Li XD, Li XK, et al.Preliminary study on the a novel individualized 3D printing artificial vertebral body in spine reconstruction[J].Chin J Orthop,2020,40(6):335-343. DOI: 10.3760/cma.j.cn121113-20200303-00128
[27]	Yang X, Wan W, Gong H, et al.Application of individualized 3D-printed artificial vertebral body for cervicothoracic reconstruction in a six-level recurrent chordoma[J]. Turk Neurosurg, 2020,30(1):149-155. DOI: 10.5137/1019-5149.JTN.25296-18.2
[28]	Mazel C, Hoffmann E, Antonietti P, et al.Posterior cervicothoracic instrumentation in spine tumors[J]. Spine (Phila Pa 1976), 2004,29(11):1246-1253. DOI: 10.1097/00007632-200406010-00015
[29]	Lee GY, Massicotte EM, Rampersaud YR.Clinical accuracy of cervicothoracic pedicle screw placement: a comparison of the "open" lamino-foraminotomy and computer-assisted techniques[J]. J Spinal Disord Tech, 2007,20(1):25-32. DOI: 10.1097/01.bsd.0000211239.21835.ad
[30]	Garg B, Mehta N.Current status of 3D printing in spine surgery[J]. J Clin Orthop Trauma, 2018,9(3):218-225. DOI: 10.1016/j.jcot.2018.08.006
[31]	Matai I, Kaur G, Seyedsalehi A, et al.Progress in 3D bioprinting technology for tissue/organ regenerative engineering[J]. Biomaterials, 2020,226:119536. DOI: 10.1016/j.biomaterials.2019.119536
[32]	孟祥晖,张志军,方策,等. 三维可视化技术在复杂骨与软组织肿瘤手术中的临床应用. 中华解剖与临床杂志,2021,26(01):68-72. DOI:10.3760/cma.j.cn101202-20200409-00121.Meng XH, Zhang ZJ, Fang C, et al.Clinical application of three-dimensional visualization technology in bone and soft tissue tumor surgery[J]. Chin J Anat Clin, 2021, 26(1):68-72. DOI:10.3760/cma.j.cn101202-20200409-00121
[33]	张同同,王中华,文杰,等.3D打印模型在颈椎肿瘤手术切除与重建中的应用[J].中国组织工程研究,2021,25(9):1335-1339.Zhang TT, Wang ZH, Wen J, et al.Application of three-dimensional printing model in surgical resection and reconstruction of cervical tumor[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(9):1335-1339
[34]	牛国旗,代建昊,汪东,等. 个体化3D打印导向模板辅助上颈椎椎弓根螺钉置入的实验研究[J]. 中华解剖与临床杂志,2017,22(5):366-372. DOI:10.3760/cma.j.issn.2095-7041.2017.05.004.Niu GQ, Dai JH, Wang D, et al.Experimental study of individualized 3D printing navigation template in the treatment of upper cervical pedicle screw placement[J]. Chin J Anat Clin, 2017,22(5):366-372. DOI:10.3760/cma.j.issn.2095-7041.2017.05.004
[35]	纪经涛,胡永成,苗军. 3D打印人工椎体在胸腰椎肿瘤整块切除后重建中的应用. 中华骨科杂志,2020,40(4):208-216. DOI:10.3760/cma.j.issn.0253-2352.2020.04.003.Ji JT, Hu YC, Miao J.Application of 3D printed porous artificial vertebra in reconstruction of thoracolumbar tumor[J]. Chin J Orthop, 2020,40(4): 208-216. DOI: 10.3760/cma.j.issn.0253-2352.2020.04.003
[36]	菅强,许文龙,段婉茹, 等.个体化定制3D打印假体枢椎前柱重建治疗枢椎肿瘤的疗效观察[J].中国脊柱脊髓杂志,2020,30(9):804-810.DOI:10.3969/j.issn.1004-406X.2020.09.06.Jian Q, Xu WL, Duan WR, et al.Clinical observation on the application of customized 3D printed prosthetic body weight in the treatment of axial tumors[J]. Chinese Journal of spine and spinal Cord, 2020, 30(9):804-810. DOI:10.3969/j.issn.1004-406X.2020.09.06
[37]	韦峰,刘杉杉,刘忠军, 等.胸腰椎肿瘤整块切除后应用3D打印人工椎体重建的安全性和有效性研究[J].中国脊柱脊髓杂志,2020,30(9):774-781.DOI:10.3969/j.issn.1004-406X.2020.09.02.Wei F, Liu BB, Liu ZJ, et al.Study on the safety and effectiveness of 3D printed artificial vertebral body reconstruction after en bloc resection of thoracolumbar tumor[J]. Chinese Journal of Spine and Spinal Cord, 2020, 30(9):774-781.DOI:10.3969/j.issn.1004-406X.2020.09.02.