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Computer-aided resection and endoprosthesis design for the management of malignant bone tumors around the knee: outcomes of 12 cases.

Ding HW, Yu GW, Tu Q, Liu B, Shen JJ, Wang H, Wang YJ - BMC Musculoskelet Disord (2013)

Bottom Line: In all cases pathologically confirmed clear surgical margins were obtained.All patients are able to ambulate freely without restrictions.At the last follow-up, the average International Society of Limb Salvage score was 25.8 (range, 18 to 27), and was excellent in 8 cases and good in 4 cases.

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Materials Science and Engineering, South China University of Technology, Guangzhou, Guangdong 510010, China. dhuanwen123@aliyun.com.

ABSTRACT

Background: To report the outcomes of computer-aided resection and endoprosthesis design for the management of malignant bone tumors around the knee.

Methods: Computed tomography (CT) and magnetic resonance imaging (MRI) data were input into computer software to produce three-dimensional (3D) models of the tumor extent. Imaging data was then used to create a template for surgical resection, and development of an individualized combined allogeneic bone/endoprosthesis. Surgical simulations were performed prior to the actual surgery.

Results: This study included 9 males and 3 females with a mean age of 25.3 years (range, 13 to 40 years). There were 9 tumors in the distal femur and 3 in the proximal tibia. There were no surgical complications. In all cases pathologically confirmed clear surgical margins were obtained. Postoperative radiographs showed the range of tumor resection was in accordance with the preoperative design, and the morphological reconstruction of the bone defect was satisfactory with complete bilateral symmetry. The mean follow-up time was 26.5 months. Two patients died of their disease and the remaining are alive and well without evidence of recurrence. All patients are able to ambulate freely without restrictions. At the last follow-up, the average International Society of Limb Salvage score was 25.8 (range, 18 to 27), and was excellent in 8 cases and good in 4 cases.

Conclusions: Computer-aided design and modeling for the surgical management of bone tumors and subsequent limb reconstruction provides accurate tumor removal with the salvage of a maximal amount of unaffected bone and precise endoprosthesis reconstruction.

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Related in: MedlinePlus

Intraoperative photos. A) Auxiliary template for tumor resection was installed. B) Resected specimen. C) Allogenic bone with template for trimming. D) Trimmed allogeneic bone. E) The trimmed allogeneic bone with prosthesis installed. F) Distal femur implant in place. G) Template for drilling holes in the allogenic bone. H) Allogeneic bone was used to cover the junction zone and fixed with a double wire band.
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Figure 4: Intraoperative photos. A) Auxiliary template for tumor resection was installed. B) Resected specimen. C) Allogenic bone with template for trimming. D) Trimmed allogeneic bone. E) The trimmed allogeneic bone with prosthesis installed. F) Distal femur implant in place. G) Template for drilling holes in the allogenic bone. H) Allogeneic bone was used to cover the junction zone and fixed with a double wire band.

Mentions: The distal femur was exposed, and the auxiliary tumor resection template was installed to guide the osteotomy (Figure 4A) and precise tumor resection (Figure 4B). An allogeneic trimming template was installed on the allogeneic bone (Figure 4C), and the allogeneic bone was trimmed to a 3D shape matching the bone defect area (Figure 4D). An allogeneic tendon was passed through both sides of the distal part of the allogeneic bone for collateral ligament reconstruction. The trimmed allogeneic bone was combined with the prosthesis, and bone cement was applied to fix the related parts to form an individualized prosthesis for bone defect repair (Figure 4E).


Computer-aided resection and endoprosthesis design for the management of malignant bone tumors around the knee: outcomes of 12 cases.

Ding HW, Yu GW, Tu Q, Liu B, Shen JJ, Wang H, Wang YJ - BMC Musculoskelet Disord (2013)

Intraoperative photos. A) Auxiliary template for tumor resection was installed. B) Resected specimen. C) Allogenic bone with template for trimming. D) Trimmed allogeneic bone. E) The trimmed allogeneic bone with prosthesis installed. F) Distal femur implant in place. G) Template for drilling holes in the allogenic bone. H) Allogeneic bone was used to cover the junction zone and fixed with a double wire band.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4222761&req=5

Figure 4: Intraoperative photos. A) Auxiliary template for tumor resection was installed. B) Resected specimen. C) Allogenic bone with template for trimming. D) Trimmed allogeneic bone. E) The trimmed allogeneic bone with prosthesis installed. F) Distal femur implant in place. G) Template for drilling holes in the allogenic bone. H) Allogeneic bone was used to cover the junction zone and fixed with a double wire band.
Mentions: The distal femur was exposed, and the auxiliary tumor resection template was installed to guide the osteotomy (Figure 4A) and precise tumor resection (Figure 4B). An allogeneic trimming template was installed on the allogeneic bone (Figure 4C), and the allogeneic bone was trimmed to a 3D shape matching the bone defect area (Figure 4D). An allogeneic tendon was passed through both sides of the distal part of the allogeneic bone for collateral ligament reconstruction. The trimmed allogeneic bone was combined with the prosthesis, and bone cement was applied to fix the related parts to form an individualized prosthesis for bone defect repair (Figure 4E).

Bottom Line: In all cases pathologically confirmed clear surgical margins were obtained.All patients are able to ambulate freely without restrictions.At the last follow-up, the average International Society of Limb Salvage score was 25.8 (range, 18 to 27), and was excellent in 8 cases and good in 4 cases.

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Materials Science and Engineering, South China University of Technology, Guangzhou, Guangdong 510010, China. dhuanwen123@aliyun.com.

ABSTRACT

Background: To report the outcomes of computer-aided resection and endoprosthesis design for the management of malignant bone tumors around the knee.

Methods: Computed tomography (CT) and magnetic resonance imaging (MRI) data were input into computer software to produce three-dimensional (3D) models of the tumor extent. Imaging data was then used to create a template for surgical resection, and development of an individualized combined allogeneic bone/endoprosthesis. Surgical simulations were performed prior to the actual surgery.

Results: This study included 9 males and 3 females with a mean age of 25.3 years (range, 13 to 40 years). There were 9 tumors in the distal femur and 3 in the proximal tibia. There were no surgical complications. In all cases pathologically confirmed clear surgical margins were obtained. Postoperative radiographs showed the range of tumor resection was in accordance with the preoperative design, and the morphological reconstruction of the bone defect was satisfactory with complete bilateral symmetry. The mean follow-up time was 26.5 months. Two patients died of their disease and the remaining are alive and well without evidence of recurrence. All patients are able to ambulate freely without restrictions. At the last follow-up, the average International Society of Limb Salvage score was 25.8 (range, 18 to 27), and was excellent in 8 cases and good in 4 cases.

Conclusions: Computer-aided design and modeling for the surgical management of bone tumors and subsequent limb reconstruction provides accurate tumor removal with the salvage of a maximal amount of unaffected bone and precise endoprosthesis reconstruction.

Show MeSH
Related in: MedlinePlus