Department of Orthop. Surgery, Diaconial Hospital Hamburg, Juetlaender Allee 48, Hamburg 22527, Germany.
Eur J Surg Oncol. 2010 Jun;36(6):594-8. doi: 10.1016/j.ejso.2009.11.005. Epub 2010 Feb 18.
Resection of malignant tumors of the pelvis is demanding. To avoid disabling hemipelvectomies, years ago internal hemipelvectomy combined with partial pelvic replacements had become a surgical procedure. To achieve adequate reconstructions custom-made replacements were recommended. In early stages of the surgical procedure using megaprostheses, individual pelvic models were manufactured.
Since little is known about the accuracy of such models we analysed the charts of 24 patients (25 models) for whom an individual model of the osseous pelvis had been manufactured.
Two patients refused surgery. In 23 patients partial resection of the bony pelvis was performed followed by a partial pelvic replacement (13x), hip transposition procedure (5x), ilio-sacral resection (4x), or revision surgery. In all patients who received a partial pelvic replacement, the fit of the replacement was optimal. No major unplanned resection was necessary. The same was observed in patients who received a hip transposition procedure or an ilio-sacral resection. Oncologically, in most of the patients we achieved wide resection margins (14x). In 5 patients the margins were marginal (4x) or intralesional (1x). In two cases the aim was a palliative resection because of a metastatic disease (1x) or benign entity (1x).
Pelvic models are helpful tools to planning the manufacture of partial pelvic replacements and ensuring optimal osseous resection of the involved bone. Further attempts have to be made to evaluate the aim of navigational techniques regarding the accuracy of the osseous and soft-tissue resection.
骨盆恶性肿瘤的切除要求很高。为了避免致残性半骨盆切除术，数年前，内半骨盆切除术结合部分骨盆置换术已成为一种手术方法。为了实现充分的重建，建议使用定制假体。在手术早期使用大型假体时，会制造个体化的骨盆模型。
由于对这些模型的准确性知之甚少，我们分析了 24 名患者（25 个模型）的图表，这些患者接受了个体化骨盆模型的制造。
两名患者拒绝手术。23 名患者接受了骨盆骨部分切除术，随后进行了部分骨盆置换术（13 例）、髋关节置换术（5 例）、髂-骶切除术（4 例）或翻修手术。在所有接受部分骨盆置换术的患者中，置换物的适配均为最佳。无需进行重大计划外切除。接受髋关节置换术或髂-骶切除术的患者也是如此。在大多数患者中，我们实现了广泛的肿瘤切缘（14 例）。在 5 名患者中，切缘为边缘性（4 例）或瘤内性（1 例）。在 2 例中，由于转移性疾病（1 例）或良性实体瘤（1 例），手术目的为姑息性切除。
骨盆模型是规划部分骨盆置换术制造和确保受累骨充分骨切除的有用工具。需要进一步努力评估导航技术在骨和软组织切除的准确性方面的目标。
