[骨盆及髋臼周围恶性肿瘤切除后鞍形假体半骨盆重建：附12例报告]

Fu Ming, Shen Jing-Nan, Huang Gang, Wang Jin, Fu Qi-Zhen, Yang Zhong-Han

Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, PR China.

Ai Zheng. 2007 Nov;26(11):1237-42.

BACKGROUND & OBJECTIVE: Malignant tumors around the pelvis and acetabulum locate deeply with complex anatomic structure, meanwhile, the resection area involves the weight-loading alignment. Therefore, tumor resection plus acetabular joint reconstruction is a complicated operation. This study was to summarize our experience of tumor resection plus prosthesis reconstruction of the acetabular joint for this disease.

METHODS

Clinical data of 12 patients with malignant tumors around the pelvis and acetabulum, treated with tumor resection plus prosthesis reconstruction of the acetabular joint from 1995 to 2006, were reviewed. The characteristics of the operating for this disease were analyzed in terms of preoperative preparation, operating strategy, prosthesis design, operating procedure, acetabular reconstruction, and postoperative rehabilitation.

RESULTS

The patients were followed for 8-86 months, with a median of 46 months. Of the 4 patients with tumor relapse, 2 osteosarcoma patients died of lung metastasis at 15 months and 22 months after operation; 1 chondrosarcoma patient relapsed locally at 26 months after operation and died at 38 months after operation; 1 giant cell tumor patient relapsed locally at 13 months after operation and was treated by clearance of focal lesion, and survived tumor-freely till the end of follow-up. The other 9 patients still survived tumor-freely till the end of follow-up. The 1-year survival rate was 75.0%; the 3-and 5-year survival rates were 33.3%; the 7-year survival rate was 25.0%. According to Harris scoring criteria after total hip replacement, 3 patients scored 60-69, 5 scored 70-79, and 4 scored 80-90 in limb function.

CONCLUSIONS

Pelvic tumor resection and prosthesis reconstruction of the acetabular joint has the characteristics of difficulty and high-risk. For bone tumors with relatively low malignancy, this surgical treatment is an ideal option.

背景与目的

骨盆及髋臼周围恶性肿瘤位置深，解剖结构复杂，且切除范围涉及负重对线。因此，肿瘤切除加髋臼关节重建是一项复杂的手术。本研究旨在总结我们对该病行肿瘤切除加髋臼假体重建的经验。

方法

回顾1995年至2006年采用肿瘤切除加髋臼假体重建治疗的12例骨盆及髋臼周围恶性肿瘤患者的临床资料。从术前准备、手术策略、假体设计、手术步骤、髋臼重建及术后康复等方面分析该病的手术特点。

结果

患者随访8 - 86个月，中位随访时间46个月。4例肿瘤复发患者中，2例骨肉瘤患者分别于术后15个月和22个月死于肺转移；1例软骨肉瘤患者术后26个月局部复发，术后38个月死亡；1例骨巨细胞瘤患者术后13个月局部复发，经病灶清除治疗后至随访结束无瘤生存。其余9例患者至随访结束仍无瘤生存。1年生存率为75.0%；3年和5年生存率均为33.3%；7年生存率为25.0%。根据全髋关节置换术后Harris评分标准，肢体功能评分60 - 69分者3例，70 - 79分者5例，80 - 90分者4例。