Objective: To explore the possible clinical benefits of CT/MRI image fusion and computer-assisted simulation techniques in guiding type Ⅲ and Ⅳ primary pelvic bone tumor surgeries. Methods: The clinic data of primary bone sarcomas patients treated at Department of Bone and Soft Tissue,Zhenghzhou University Affiliated Cancer Hospital from January 2019 to December 2021 were retrospectively analyzed. Based on whether the CT and MRI image fusion technique was utilized for tumor evaluation and surgical planning,the patients were divided into image fusion group (n=21) or control group (n=27). There were 7 male and 14 female patients included in the image fusion group, with the age of (37.0±10.4) years(range: 18 to 67 years). In the control group, there were 10 males and 17 females with the age of (39.7±15.2) years (range: 16 to 65 years). Both groups included osteosarcoma,chondrosarcoma and undifferentiated polymorphic sarcoma as the pathological diagnosis. Clinical information such as gender,age,pathological diagnosis,location of disease,and metastasis at diagnosis were collected. Surgical related information such as duration of surgery,blood loss,surgical margin,and wound complications were also obtained. Periodical follow-ups every 3 months were performed for all patients to monitor the status of local recurrence,distant metastasis,and survival information. Independent t test and χ² test were used for data comparison between groups. Results: Significant reduced duration of surgery was observed in the image fusion group in comparison with control group both in type Ⅲ and Ⅳ surgeries ((144.0±31.6)min vs. (248.2±56) min,t=-8.084, P<0.01); (173.0±42.0)min vs. (306.1±62.0)min, t=-4.518, P<0.01). Blood loss was significantly reduced in the image fusion group compared with the control group ((484.8±226.3)ml vs. (836.1±359.8)ml,t=-4.130, P<0.01). In addition, significant lower ratio of R1 margin and recurrence rates of type Ⅲ and Ⅳ surgeries were found in the image fusion group comparing with the control group (4.8%(1/21) vs. 22.2%(6/27), χ²=4.214, P=0.040; 4.8%(1/21) vs. 22.2%(6/27), χ²=4.214, P=0.040).In the image fusion group, there were 3 cases of incision infection, 1 of which underwent secondary debridement.And in thecontrol group there were 7 cases of incision infection, 3 of which underwent secondary debridement. There was no significant difference in the incidence of complications between the two groups (14.2%(3/21)vs. 25.9%(7/27), χ²=0.645, P=0.422). Up to the last follow-up, 1 patient died in the image fusion group and 2 patients died in the control group, the difference was not statistically significant (χ²=1.885, P=0.220). Conclusion: Compared with the traditional operation,the image fusion technique can significantly reduce the duration of surgery,blood loss and lower the recurrence rate by achieving better surgical margins.
目的： 探讨CT、MRI图像融合及计算机模拟技术在Ⅲ、Ⅳ区骨盆恶性肿瘤手术中的临床应用效果。 方法： 回顾性分析2019年1月至2021年12月河南省肿瘤医院骨与软组织科收治的48例骨盆恶性肿瘤患者的临床资料。根据是否应用图像融合技术分为图像融合组（21例）及对照组（27例）。图像融合组男性7例，女性14例，年龄（37.0±10.4）岁（范围：18~67岁）；对照组男性10例，女性17例，年龄（39.7±15.2）岁（范围：16~65岁）。两组患者病理学类型均包含骨肉瘤、软骨肉瘤及未分化多形性肉瘤。收集患者手术时间、切缘情况、术中出血量、术后切口并发症及肿瘤复发、转移和患者死亡情况等。数据比较采用独立样本t检验或χ²检验。 结果： 图像融合组骨盆Ⅲ区、Ⅳ区肿瘤患者的手术时间均比对照组短［（144.0±31.6）min比（248.2±56.6）min，t=-8.084，P<0.01；（173.0±42.0）min比（306.1±62.0）min，t=-4.518，P<0.01］，R1切缘比例及复发率均更低［4.8%（1/21）比22.2%（6/27），χ²=4.214，P=0.040；4.8%（1/21）比22.2%（6/27），χ²=4.214，P=0.040］，图像融合组术中出血量更少［（484.8±226.3）ml比（836.1±359.8）ml，t=-4.130，P<0.01］，差异均有统计学意义。图像融合组术后出现3例切口感染，其中1例进行二次清创手术；对照组出现7例切口感染，其中3例进行二次清创手术，两组并发症发生率的差异无统计学意义［14.2%（3/21）比25.9%（7/27），χ²=0.645，P=0.422］。截至末次随访，图像融合组1例患者死亡，对照组2例死亡，差异无统计学意义（χ²=1.885，P=0.220）。 结论： 与传统方式相比，图像融合技术指导下的骨盆肿瘤手术的手术时间更短和术中出血量更少，更有利于实现阴性切缘并降低肿瘤术后复发率。.