累及髋臼的骨盆软骨肉瘤的外科治疗。

Surgical treatment of pelvic chondrosarcoma involving periacetabulum.

机构信息

Musculoskeletal Tumor Center, People's Hospital, Peking University, Xicheng District, Beijing 100083, China.

出版信息

J Surg Oncol. 2010 Feb 1;101(2):160-5. doi: 10.1002/jso.21442.

DOI:10.1002/jso.21442

PMID:19960486

Abstract

BACKGROUND AND OBJECTIVES

Surgical treatment of pelvic chondrosarcoma involving acetabulum is challenging. Primary goals of surgical treatment include local control and prevention of distant metastases. A secondary goal is maintenance of quality of life by avoiding major amputative surgery. The purpose of the study was to review the oncological outcome, functional outcome, and the surgical complications of patients with periacetabular chondrosarcomas in the context of resection and reconstruction treated at one tumor center in the past decade.

METHODS

Forty-five cases between June 1998 and June 2007 were retrospectively reviewed. There were 26 men and 19 women with an average age of 41.2 (18-63) years. Patients were followed up for a median time of 37 months (18-119 months). There were 32 patients with conventional chondrosarcomas, 9 with dedifferentiated chondrosarcomas, and 4 with mesenchymal chondrosarcomas. According to Enneking's classification there were: Type II-1, Type I + II-8, Type II + III-23, Type I + II + IV-8, and Type I + II + III-5. Six patients had an external hemipelvectomy, whereas 39 patients underwent a limb-salvage procedure. In 27 patients the defect was reconstructed by a modular hemipelvic endoprosthesis and in 4 patients reconstruction by saddle endoprosthesis. Five patients received reconstruction with devitalized tumor bone and three underwent iliofemoral arthrodesis.

RESULTS

The 5-year estimated survival was 62.6%. Local recurrence occurred in 10 (22.2%) patients at an average of 18 months after operations. Ten (22.2%) patients had distant metastasis. The average MSTS 93 score was 68.3% (33.3-100). Eighteen complications occurred in 13 patients (28.9%). Wound complication occurred in six (13.3%) patients. Deep infection rate was 11.1%.

CONCLUSIONS

Favorable oncological and functional outcome can be achieved in selected patients with periacetabular chondrosarcomas. The complication rates were still high; however, facing the goal of limb salvage, a certain number of complications is acceptable.

摘要

背景与目的

涉及髋臼的骨盆软骨肉瘤的外科治疗极具挑战性。外科治疗的主要目标包括局部控制和预防远处转移。次要目标是通过避免主要截肢手术来维持生活质量。本研究的目的是回顾在过去十年中，在一个肿瘤中心接受切除和重建治疗的髋臼软骨肉瘤患者的肿瘤学结果、功能结果和手术并发症。

方法

回顾性分析 1998 年 6 月至 2007 年 6 月期间的 45 例病例。男性 26 例，女性 19 例，平均年龄 41.2（18-63）岁。患者的中位随访时间为 37 个月（18-119 个月）。其中 32 例为常规软骨肉瘤，9 例为去分化软骨肉瘤，4 例为间叶性软骨肉瘤。根据 Enneking 分类：Ⅱ-1 型 6 例，Ⅰ+Ⅱ-8 型，Ⅱ+Ⅲ-23 型，Ⅰ+Ⅱ+Ⅳ-8 例，Ⅰ+Ⅱ+Ⅲ-5 例。6 例患者行外半骨盆切除术，39 例行保肢手术。27 例患者采用模块化半骨盆假体进行缺损重建，4 例患者采用鞍状假体进行重建。5 例患者采用灭活肿瘤骨重建，3 例行髂股关节融合术。