Surgical treatment of bone tumor using computer-assisted navigation

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Objective To analyze the security and effectiveness of computer-assisted navigation used in the preoperative design,accurate resection and reconstruction of bone tumor. Methods From February 2009 to August 2011,tumor resections and reconstructions assisted by computer-assisted navigation were performed in 39 patients with musculoskeletal tumor.They were 21 males and 18 females.Tumors occurred in the pelvis in 20 cases,in the distal femur in 9.in the proximal tibia in 6 and in the spine in 4.The preoperative CT scans and MRI images of all patients were transformed into data at.dicom format and imported into the navigation system.The computer analyzed the data,reconstrueted the anatomical structure of the tumor,displayed and marked the accurate border of the tumor.After the area was defined,resection of the bonc tumor was perfomed strictly under the guidance of navigation,and reconstruction accomplished with the proper prostheses or allograft bones preoperatively designed.The local recurrence of tumor and surgical margin were appraised postoperatively.and the function was assessed according to MSTS93 evaluation system.Results The intraoperative anatomic registration points were coincident with those by the preoperativu design,with an average crror of 0.52mm (from 0.4to 0.7mm).Accurate tumor resection and satisfactory reconstruction were performed on schedule in 36 patients,without intraoperative injury to nerves,vessels or organs.The pathological tumor samples showed satisfactory surgical margins without residual tumor.The avcrage follow-up was 19.5 months (range,3 to 32 months).Local recurrence was found in 5 malignant cases,including 3 pelvic and 2 limb cases as well as 3 cases of pulmonary metastasis.The average MSTS93 functional soore was 24.8 (from 22 to 28) points. Conclusions Computer-assisted navigation system is a safe and effectiv assistance for accurate resection and reconstruction of musculoskeletal tumor.It helps avoiding blindness in tumor resection and arbitrary reconstrution.It can also reduce the recurrence rate and improve functional recoveru. Key words: Surgcry, computer-assisted; Bone neoplasms; Reconstructive surgical procedures