Satcher Robert L, O'Donnell Richard J, Johnston James O
Northwestern University, The Feinberg School of Medicine, Orthopaedic Oncology Division, Department of Orthopaedic Surgery, Chicago, IL 60611, USA.
Clin Orthop Relat Res. 2003 Apr(409):209-17. doi: 10.1097/01.blo.0000057791.10364.7c.
Periacetabular resections for primary malignancies and metastatic disease require reconstruction to restore weightbearing along anatomic axes. Without reconstruction, patients are unable to ambulate independently, and are left with a disfigured pelvis and shortened limb. The current authors describe a reconstruction technique using Steinmann pins augmented with methylmethacrylate reconstruction, and autoclaved autografting, in combination with total hip arthroplasty, after resection of primary sarcomas of the pelvis. For this study, the results of 15 patients at two institutions who had surgery by the same surgeons were retrospectively reviewed. The patients had primary malignant tumors of the pelvis, and had limb-sparing resections between 1985 and 2000. Three measures of outcome were evaluated: survival, function, and pain. The surgical method uses Steinmann pins with bone cement to fill in areas of bone loss that cannot be reconstructed with autoclaved autograft. A constrained polyethylene acetabular component is cemented into this bed. Twelve patients had chondrosarcoma and one patient had osteosarcoma. The remaining two patients had alveolar sarcoma of soft parts. Six patients died of disease. Seven patients were alive with no evidence of disease, and two were alive with disease at the most recent followup. Early return to ambulation without assistive devices occurred in nine of 15 patients. The functional outcome of this technique compares favorably with others reported. Sixty percent of patients ambulated independently without assistive devices, compared with 0% to 10% in other studies reviewed. The time required for independent gait is similar to recovery from a total hip arthroplasty. Moreover, this method minimized leg length discrepancy, while also producing a favorable cosmetic result.
髋臼周围原发性恶性肿瘤和转移性疾病的切除术需要进行重建，以沿解剖轴恢复负重功能。如果不进行重建，患者将无法独立行走，骨盆会变形，肢体也会缩短。本文作者描述了一种重建技术，即在骨盆原发性肉瘤切除术后，采用斯氏针联合甲基丙烯酸甲酯重建及高压灭菌自体骨移植，并结合全髋关节置换术。在本研究中，回顾性分析了两家机构中由同一组外科医生进行手术的15例患者的结果。这些患者患有骨盆原发性恶性肿瘤，并在1985年至2000年间接受了保肢切除术。评估了三项预后指标：生存率、功能和疼痛。该手术方法是使用斯氏针和骨水泥填充无法用高压灭菌自体骨重建的骨缺损区域。将一个限制性聚乙烯髋臼组件用骨水泥固定在这个部位。12例患者患有软骨肉瘤，1例患者患有骨肉瘤。其余2例患者患有软组织肺泡肉瘤。6例患者死于疾病。7例患者存活且无疾病证据，2例患者在最近一次随访时仍患有疾病。15例患者中有9例早期无需辅助装置即可恢复行走。该技术的功能预后与其他报道的技术相比具有优势。60%的患者无需辅助装置即可独立行走，而在其他综述研究中这一比例为0%至10%。独立步态所需的时间与全髋关节置换术后的恢复时间相似。此外，这种方法最大限度地减少了肢体长度差异，同时也产生了良好的美容效果。
