Computer navigation used in precise resection and jiont-sparing surgery for limbs with malignant bone tumor

Abstract

Objective To report our experience of using image-guided computer navigation for precise resection and joint-sparing reconstruction in musculoskeletal tumor surgery. Methods Between September 2008 and March 2011 surgical resections and joint-sparing reconstruetions,with assistance of imag-guided computer navigation,were performed for 12 patients with malignant bone tumors,There were 5 femals and 7 males,with an average age of 26.7years (from 12 to 59 years).The tumor was located at distal femur diaphysis in 8 cases,at proximal tibia in 3 and at distal tibia in one.By pathological diagnosis,there were 7 osteosarcoms,3 chondrosarecomas,one hemendothelioma and one spindal cell saroma.Three-dimensiomal models of bone tumor were reconstructed for each patient on the basis of prcoperative CT and MRI data.Using the models,we made preoperative plan for each patient with the navigation system software to locate tumor surgical margin and design rsection and reconstruction with a custom-made jdint-sparing prosthesis for femur tumors and an allograft for tibia tumors.Intraoperatively.we carred out theprocess of registration and matching the operative anatomy to the virtual image generated by the navigation system software.Then we performed surgical processes according to the preoperative.plan. Results The tumor resections and joint-spariug reconstructiorns with custom-made prostheses and allografts were completed for all cases as precisely as preopcrative plan designed.All the resection specimens showed a safe and clear marghn.The average distance from the resection margin to the joint were 35 mm ( from 12 mm to 80 mm).All the patients were followed for an average of 21 months (from 7 to 37 months).By the Musculoskeletal.Tumor Sociery (MSTS) evalnation system,the patients achieved 92％to 96％ of limb fuctional recovery (average,94％ ).No wound or joint infection,no local relapse or remote metastasis occurred. Conclusion The image-guided computer navigation system greatly facilitate precise resection and joint-sparing reconstruction for patients with bone tumor near the joint. Key words: Bone tunmor; Surgery, computer-assisted; Prosthesis implantation