Hillmann A, Hoffmann C, Gosheger G, Rödl R, Winkelmann W, Ozaki T
Department of Orthopedics, Westfälische Wilhelms-Universität, Albert-Schweitzer Strasse 33, 48149 Münster, Germany.
Arch Orthop Trauma Surg. 2003 Sep;123(7):340-4. doi: 10.1007/s00402-003-0543-7. Epub 2003 Jun 28.
Complications after pelvic sarcoma surgery are frequent; however, the reports on complications are limited. Results of the authors' experience with 110 primary pelvic tumor resections and methods to achieve low complication rates for pelvic reconstruction are reported.
From 1982 to 1996, 110 patients with pelvic sarcoma (42 Ewing sarcomas, 40 chondrosarcomas, 21 osteosarcomas, and 7 other malignant tumors) underwent surgery. Sixteen patients underwent implantation of a hemipelvic megaprosthesis, 13 patients had implantation of an allograft for sacroiliac arthrodesis, 12 patients had implantation of an autograft for sacroiliac arthrodesis, and 17 patients underwent hip transposition. There were 9 hindquarter amputations, 6 implantations of allograft and total hip endoprosthesis, 1 implantation of prosthesis with autograft, and 1 implantation of allograft and autograft. No skeletal reconstruction was done in 35 patients.
Postoperative function was as follows: 37% in patients with prosthesis, 60% in allograft, 66% in autograft, 66% in hip transposition, 37% in amputation, and 79% without reconstruction. In total, 10/16 patients with prosthetic replacement, 9/13 with allograft implantation, 4/12 with autograft implantation, 7/17 with hip transposition, 5/9 with amputation, 6/6 with prosthesis and allograft, and 12/35 without skeletal reconstruction had complications. Frequent complications depending on the reconstruction were infection in 6/10 prostheses and in 5/13 allografts, leg length discrepancy in 2/12 autografts and 4/17 hip transpositions, hematoma in 3/9 amputations, and infection (6) and skin problems (5) in 6 prostheses with allograft.
Because of the small number of complications and good function, autograft implantation after iliac resection and hip transposition after acetabular resection are advisable.
骨盆肉瘤手术后并发症很常见；然而，关于并发症的报告有限。本文报告了作者对110例原发性骨盆肿瘤切除术的经验以及实现低骨盆重建并发症发生率的方法。
1982年至1996年，110例骨盆肉瘤患者（42例尤因肉瘤、40例软骨肉瘤、21例骨肉瘤和7例其他恶性肿瘤）接受了手术。16例患者植入了半骨盆大型假体，13例患者植入同种异体骨进行骶髂关节融合术，12例患者植入自体骨进行骶髂关节融合术，17例患者接受了髋关节移位术。9例行后肢截肢术，6例植入同种异体骨和全髋关节假体，1例植入假体并自体骨移植，1例植入同种异体骨和自体骨。35例患者未进行骨骼重建。
术后功能如下：假体植入患者为37%，同种异体骨患者为60%，自体骨患者为66%，髋关节移位患者为66%，截肢患者为37%，未重建患者为79%。总体而言，16例假体置换患者中有10例、13例同种异体骨植入患者中有9例、12例自体骨植入患者中有4例、17例髋关节移位患者中有7例、9例截肢患者中有5例、6例假体和同种异体骨患者中有6例以及35例未进行骨骼重建患者中有12例出现并发症。根据重建方式，常见并发症包括：10例假体中有6例、13例同种异体骨中有5例发生感染；12例自体骨中有2例、17例髋关节移位中有4例出现肢体长度差异；9例截肢中有3例出现血肿；6例假体和同种异体骨中有6例发生感染，5例出现皮肤问题。
由于并发症数量少且功能良好，髂骨切除术后自体骨植入和髋臼切除术后髋关节移位是可取的。
