摘要/Abstract
摘要： 目的 ·初步探讨基于影像图像数字化处理及 3D打印技术设计的个体化导板应用于骨肿瘤经皮穿刺活检手术的可行性。方法 ·回顾性分析 2017年 7月—2018年 3月以骨肿瘤诊断收治入上海交通大学医学院附属第九人民医院行活检穿刺的患者 11例（男 6例，女 5例；年龄 7～ 69岁，平均 36岁）。术前常规行 CT和 MRI增强检查， DICOM数据导入 Medraw Print软件，记录肿瘤的大小、位置；骨科医师明确进针方位后，依据特定骨肿瘤区域的解剖结构，设计并 3D打印个体化穿刺导板。记录术中 3D打印个体化导板与穿刺解剖结构匹配程度及进针位置，观察术后有无并发症。以 X线或 CT证实穿刺是否成功，并以开放手术的病理结果为参考标准，评估穿刺结果的准确性。结果 · 11例患者包括股骨 4例、骨盆 3例、胫骨 2例、肩胛骨及掌骨各 1例，3D打印个体化导板基本贴合穿刺部位解剖结构，进针方位深度均与术前设计方案一致，术中无重要解剖结构损伤，术后未出现血管、神经损伤症状。 8例（88.9%）患者穿刺送检组织与术后病理良恶性结果基本一致， 2例患者因穿刺活检为良性肿瘤未行骨肿瘤切除术。结论 ·基于影像图像数字化处理及 3D打印技术设计的个性定制导板能够实现骨肿瘤的精准穿刺，对提升骨肿瘤术前诊断的准确性以及优化治疗方案具有重要意义。
关键词: 骨肿瘤, 个体化穿刺导板, 活检手术, 3D打印技术, 图像配准融合
Abstract:
Objective · To explore the feasibility of applying customized guide, based on digital image processing and 3D printing technology, to bone biopsy. Methods · Eleven patients (6 males and 5 females; 7-69 years old, average age of 36 years) diagnosed with bone tumor July 2017 to March 2018 in Shanghai Ninth Peoples Hospital were enrolled in this study. Routine CT and/or MRI data were taken as reference in designing the customized biopsy guide for 3D printingMedraw Print software. Needle insertion points were set under the supervision of surgeons to avoid damaging important anatomical structures such as nerves and blood vessels. 3D printed customized guide was designed to match local surface. The success of the puncture was confirmedX-ray or CT, and the accuracy of the puncture results was evaluatedthe pathological results of resection operation as a reference standard. The complications were analyzed. Results · The 11 patients included 4 cases with neoplasms in femur, 3 cases in pelvis, 2 cases in tibia, 1 case in scapula and 1 case in metacarpal. The needling positions in operation were consistent with the preoperative virtual design, and the guide plates fitted perfectly to the body surface. The results of biopsy of 8 patients (88.9%) matched with the postoperative pathology, while another 2 patients did not receive bone tumor resection becaof the benign biopsy. No complications were observed during or after the procedure. Conclusion · Customized guidedigital image processing and 3D printing may have a great value in improving the accuracy of preoperative tumor diagnosis and the effectiveness of its treatment.
Key words: bone tumor, customized guide, biopsy, 3D printing technology, image registration and fusion
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