微創手術應用於骨腫瘤的治療

Minimally Invasive Surgery in Treatment of Bone Tumors

吳凱文(Karl Wu) ； 張至宏(Chih-Hung Chang) ； 楊榮森(Rong-Sen Yang)

《台灣醫學》 19卷1期 (2015/01) Pp. 49-53

https://doi.org/10.6320/FJM.2015.19(1).08

摘要

在過去十年中，在醫療影像學和器械的進步，導致各種微創手術的技巧逐步被應用於骨腫瘤的治療。初期研究顯示，配合使用導航系統可安全地執行骨腫瘤切除手術，可改善手術的準確度、精準度，並可執行微創手術。在骨骼肌肉系統腫瘤使用導航系統，可將手術前的電腦斷層和磁振掃描影像重建為立體三度空間的影像，以利清楚了解手術範圍和腫瘤邊界的狀況。使用導航系統可以使得腫瘤切除更為精準，重建更精確，也可以藉由保護重要的組織達到最好的功能回復。針對囊性骨腫瘤病灶，傳統上有許多不同治療方法，但治療成績在文獻上尚無定論；台大醫院骨科在2011年發表創新、微創的治療方式，這項新的微創治療方式可以達到相當理想的治療結果，有相當高的骨癒合率和極短的癒合時間。也因此，此項手術方法可以作為囊性骨病灶的治療方法首選。使用經皮腫瘤燒灼，可以在治療骨骼和軟組織腫瘤達到很好的成功率和很少的併發症。最常見的併發症是，實施燒灼時造成周邊組織（如神經、軟骨和皮膚）的間接傷害，在施作時應特別留意保護周邊組織。

關鍵字

微創手術 ； 骨腫瘤 ； 軟組織腫瘤 ； 轉移

並列摘要

In the past decade, with the improvement in medical image technology and instruments, minimal invasive surgery has been step by step introduced into musculoskeletal tumor surgery. Initial studies have shown that navigation system can be safely used in bone tumor resection surgery. It has the potential to improve surgical precision and accuracy, and to enable minimally invasive techniques for treating skeletal tumors. The use of a navigation system in musculoskeletal tumor surgery enables the integration of per-operative CT and MRI image to generate a precise three-dimensional anatomical model of the site and the extent of the tumor. The use of navigation system allows precise resection of a tumor and accurate reconstruction of the defect thereby sparing important anatomical structures and preserving function. There are varieties of treatment modalities for cystic bone lesions, with variable outcomes reported in the literature. Colleagues from Department of Orthopaedics in National Taiwan University and Hospital introduced a novel, minimally invasive treatment method to treat simple bone cysts and compared its clinical outcomes with those treated using other methods. This new minimally invasive method achieved a favorable outcome, with a higher healing rate and a shorter time to union. Thus, it can be considered an option for initial treatment of bone cysts. Percutaneous ablation of bone and soft tissue tumors demonstrates high success and low complication rates. The most common complication is the damage to surround tissues (ex. nerve, cartilage and skin). Protection of surrounding structures is necessary.

並列關鍵字

minimal invasive surgery ； bone tumor ； soft tissue tumor ； metastasis

參考文獻

1. Amiot LP, Lang K, Putzier M, et al: Comparative results between conventional and computer-assisted pedicle screw installation in the thoracic, lumbar, and sacral spine. Spine (Phila Pa 1976) 2000;25:606-14.

2. Dutton AQ, Yeo SJ, Yang KY, et al: Computer-assisted minimally invasive total knee arthroplasty compared with standard total knee arthroplasty. A prospective, randomized study. J Bone Joint Surg Am 2008;90:2-9.

3. Jolles BM, Genoud P, Hoffmeyer P: Computer-assisted cup placement techniques in total hip arthroplasty improve accuracy of placement. Clin Orthop 2004;426:174-9.

4. Kahler DM: Navigated long-bone fracture reduction. J Bone Joint Surg Am 2009;91 (Suppl 1):102-7.

5. Cho HS, Kang HG, Kim HS, et al: Computer-assisted sacral tumor resection. A case report. J Bone Joint Surg Am 2008;90: 1561-6.