Purpose

Several technologies have been implemented in orthopedic surgery to improve surgical outcomes, usually focusing on more accurate execution of a surgical plan, but the development of the plan itself is also of great importance. The purpose of this study is to examine whether the use of preoperative computer planning platforms can improve the surgical plan?

Methods

Eight surgeons created a preoperative surgical plan to resect a distal femur parosteal osteosarcoma in two settings: (1) Using a 2-D and 3-D CT scan only (current standard); and (2) using a computer-assisted planning platform. The plans were thereafter virtually executed using a novel surgical navigation system and a Sawbones model. This simulated model was derived from, and identical to, an actual patient scenario. The outcomes of interest were the number of positive margin cuts, and the volume of the resected specimen.

Results

Using the surgical plan developed with computer assistance, there were 4 positive margin cuts made by 2 surgeons. In comparison, using standard planning, there were 14 positive margin cuts made by all 8 surgeons (p = 0.02). The resection volume was larger in the computer-assisted plans (96 ± 10 mm³) than in the standard plans (88 ± 7 mm³) (p = 0.055).

Conclusions

Computer-assisted planning significantly decreased the risk of a positive margin resection in this Sawbones tumor model used to simulate resection of a primary bone sarcoma. This proof of concept study highlights the importance of advanced surgical planning and sets the ground for developing beneficial surgical planning systems.

中文翻译：

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复杂骨肿瘤切除的计算机辅助手术计划可改善锯骨模型的负切缘结果

目的

在整形外科手术中已经采用了几种技术来改善手术效果，通常将重点放在更准确地执行手术计划上，但是制定计划本身也非常重要。这项研究的目的是检查术前计算机计划平台的使用是否可以改善手术计划？

方法

八名外科医生制定了术前手术计划，以两种情况切除远端股骨旁骨骨肉瘤：（1）仅使用2-D和3-D CT扫描（当前标准）；（2）使用计算机辅助计划平台。之后，使用新型手术导航系统和Sawbones模型对计划进行了虚拟执行。该模拟模型源自实际患者情况，并且与实际患者情况相同。感兴趣的结果是切缘阳性的数量和切除标本的数量。

结果

使用计算机辅助开发的手术计划，两名外科医生进行了4次积极切缘切除术。相比之下，使用标准计划，所有8位外科医生均进行了14次正切边术（p  = 0.02）。计算机辅助计划（96±10 mm ³）的切除体积大于标准计划（88±7 mm ³）的切除体积（p  = 0.055）。

结论

在这种用于模拟原发性骨肉瘤切除术的Sawbones肿瘤模型中，计算机辅助计划显着降低了切缘阳性的风险。这项概念验证研究突出了高级手术计划的重要性，并为开发有益的手术计划系统奠定了基础。