The orthopaedic surgery department, Xi Jing Hospital Affiliated to the Fourth Military Medical University, Xi'an, People's Republic of China.
Surg Oncol. 2010 Jun;19(2):95-105. doi: 10.1016/j.suronc.2009.04.003. Epub 2009 May 24.
Hemipelvic resections for primary malignant bone tumor require reconstruction to restore weight bearing along anatomic axes. However, reconstruction of the pelvic arch remains a major surgical challenge because of the high rate of associated complications. We designed a combined hemipelvic prosthetic system to reconstruct the pelvis and purpose of this investigation was to assess the oncology and functional outcome and complication rate following this procedures.
we retrospectively reviewed 18 patients who had primary malignant pelvic tumor resections and reconstructions with the combined hemipelvic prosthesis using pedicle screw-rod constructs augmented with antibiotic cement in combination with a special designed acetabular reinforcement shell and hip prosthesis between 2001 and 2007. Patients were examined clinically and radiographically and were assessed functionally with Musculoskeletal Tumor Society score.
Five (27.8%) patients had type II periacetabular pelvic resection and 5 (27.8%) had types I and II (periacetabular and ilium) pelvic resections. Six (33.3%) patients had types II and III (periacetabular and pubis) pelvic resections, 1 (5.6%) had types I and II and III resections and 1 (5.6%) had a types I and II and IV (periacetabular and ilium and sacrum) resections. Patient survival status, function, and complications were evaluated at a mean following up of 41 months (range, 7-73 months). Ten patients (55.6%) had no evidence of disease, five patients (27.7%) had died from their disease, and three patients (16.7%) were alive with disease. The overall survival rate was 72.2% at 5 years. Local recurrence occurred in four patients (22.2%). Six of 17 patients (35.3%) showed lung metastatic progression. The average MSTS 93 score was 65.5% and 71.7% at three months after surgery and at the last followup. Six (33.3%) patients had surgery-related complications including dislocation in 2, wound dehiscence in 2, deep-vein thrombosis in 1, screw loosening in 1 and sciatic nerve palsy in 1. There was no infection occurred in this series.
Pelvic reconstruction using combined hemipelvic prosthetic system after a limb-salvage resection is an acceptable method because of its lower complication and satisfactory functional outcome and its feasibility of reconstruction for any type of periacetabular tumor resection without elaborate preoperative customize.
Level IV, therapeutic study.
原发性恶性骨肿瘤的半骨盆切除术需要重建以恢复解剖轴上的承重。然而，由于相关并发症发生率高，骨盆弓的重建仍然是一个主要的手术挑战。我们设计了一种组合式半骨盆假体系统来重建骨盆，本研究的目的是评估该手术的肿瘤学和功能结果以及并发症发生率。
我们回顾性分析了 2001 年至 2007 年间，18 例采用带蒂螺钉-棒结构增强抗生素水泥的组合式半骨盆假体进行原发性恶性骨盆肿瘤切除和重建的患者。对患者进行临床和影像学检查，并采用肌肉骨骼肿瘤学会评分进行功能评估。
5 例（27.8%）患者行髋臼周围型Ⅱ型骨盆切除术，5 例（27.8%）患者行髋臼周围型和髂骨型Ⅱ型骨盆切除术。6 例（33.3%）患者行髋臼周围型和耻骨型Ⅲ型骨盆切除术，1 例（5.6%）患者行髋臼周围型、髂骨型和耻骨型Ⅳ型骨盆切除术，1 例（5.6%）患者行髋臼周围型和髂骨型、骶骨型Ⅰ型和Ⅱ型骨盆切除术。患者平均随访 41 个月（7-73 个月），随访时评估患者的生存状况、功能和并发症。10 例（55.6%）患者无疾病证据，5 例（27.7%）患者死于疾病，3 例（16.7%）患者疾病仍存在。5 年总生存率为 72.2%。4 例（22.2%）患者发生局部复发。17 例患者中有 6 例（35.3%）出现肺部转移进展。术后 3 个月和末次随访时的平均 MSTS93 评分为 65.5%和 71.7%。6 例（33.3%）患者发生与手术相关的并发症，包括脱位 2 例，切口裂开 2 例，深静脉血栓形成 1 例，螺钉松动 1 例，坐骨神经麻痹 1 例。本系列无感染发生。
保肢切除术后采用组合式半骨盆假体系统进行骨盆重建是一种可接受的方法，因为其并发症发生率较低，功能结果满意，并且可以对任何类型的髋臼周围肿瘤切除进行重建，而无需术前精心定制。
Ⅳ级，治疗研究。
