PDF(Pubmed)
Abstract：
Patient specific instrumentation (PSI) and intraoperative surgical navigation (SN) can significantly help in achieving wide oncological margins while sparing bone stock in bone tumour resections. This is a systematic review aimed to compare the two techniques on oncological and functional results, preoperative time for surgical planning, surgical intraoperative time, intraoperative technical complications and learning curve. The protocol was registered in PROSPERO database (CRD42023422065). 1613 papers were identified and 81 matched criteria for PRISMA inclusion and eligibility. PSI and SN showed similar results in margins (0-19% positive margins rate), bone cut accuracy (0.3-4 mm of error from the planned), local recurrence and functional reconstruction scores (MSTS 81-97%) for both long bones and pelvis, achieving better results compared to free hand resections. A planned bone margin from tumour of at least 5 mm was safe for bone resections, but soft tissue margin couldn\'t be planned when the tumour invaded soft tissues. Moreover, long osteotomies, homogenous bone topology and restricted working spaces reduced accuracy of both techniques, but SN can provide a second check. In urgent cases, SN is more indicated to avoid PSI planning and production time (2-4 weeks), while PSI has the advantage of less intraoperative using time (1-5 min vs 15-65 min). Finally, they deemed similar technical intraoperative complications rate and demanding learning curve. Overall, both techniques present advantages and drawbacks. They must be considered for the optimal choice based on the specific case. In the future, robotic-assisted resections and augmented reality might solve the downsides of PSI and SN becoming the main actors of bone tumour surgery.
摘要：
患者专用器械（PSI）和术中手术导航（SN）可以显着帮助实现广泛的肿瘤边界，同时在骨肿瘤切除术中节省骨量。这是一个系统的评价，旨在比较两种技术在肿瘤和功能结果，手术计划的术前时间，手术术中时间,术中技术并发症和学习曲线。该协议在PROSPERO数据库(CRD42023422065)中注册。确定了1613篇论文，并为PRISMA纳入和资格制定了81项匹配标准。PSI和SN在边缘显示相似的结果（0-19％的阳性边缘率），骨切割精度（与计划误差0.3-4毫米），长骨和骨盆的局部复发和功能重建评分（MSTS81-97％），与自由手切除相比，效果更好。计划的肿瘤骨缘至少5毫米是安全的骨切除，但当肿瘤侵入软组织时，无法规划软组织边缘。此外，长截骨术，同质的骨骼拓扑结构和有限的工作空间降低了这两种技术的准确性，但SN可以提供第二次检查。在紧急情况下,SN更多是为了避免PSI计划和生产时间（2-4周），而PSI的优点是术中使用时间较少（1-5分钟vs15-65分钟）。最后,他们认为术中并发症发生率相似,学习曲线要求苛刻.总的来说,这两种技术都存在优点和缺点。必须根据具体情况考虑最佳选择。在未来,机器人辅助切除和增强现实可能会解决PSI和SN成为骨肿瘤手术的主要参与者的缺点。
