Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Clin Orthop Relat Res. 2012 Feb;470(2):594-601. doi: 10.1007/s11999-011-2117-2. Epub 2011 Oct 12.
Large bone loss and frequently irradiated existing bone make reconstructing metastatic and other nonprimary periacetabular tumors challenging. Although existing methods are initially successful, they may fail with time. Given the low failure rates of porous tantalum acetabular implants in other conditions with large bone loss or irradiated bone, we developed a technique to use these implants in these neoplastic cases where others might fail.
After local tumor curettage, a large uncemented tantalum shell (sometimes with tantalum augments) was fixed to remaining bone using numerous screws. When substantial medial bone loss was present, an antiprotrusio cage was placed over the top of the cup and secured to remaining ilium and ischium.
We retrospectively reviewed 20 patients who underwent THAs for neoplastic bone destruction with the described technique. Their mean age was 60 years (range, 22-80 years). We recorded pain and ambulatory status, pain medication use, and Harris hip scores. We assessed for progressive radiolucent lines and component migration on followup radiographs. Eleven of the 20 patients died at a mean of 17 months after surgery. The minimum followup for surviving patients was 26 months (mean, 56 months; range, 26-85 months).
Harris hip scores improved from a mean 32 preoperatively to a mean 74 postoperatively. We observed no cases of progressive radiolucent lines or component migration. Complications included one perioperative death, two superficial infections, one deep vein thrombosis, and one dislocation.
Our initial experience has made tantalum reconstruction our preferred method for dealing with major periacetabular neoplastic bone loss. Additional studies comparing this technique with alternatives are required.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
大块骨缺失和经常接受放射治疗的现有骨使得重建转移性和其他非原发性髋臼周围肿瘤具有挑战性。尽管现有方法最初是成功的，但随着时间的推移，它们可能会失效。鉴于多孔钽髋臼植入物在其他伴有大块骨缺失或放射治疗骨的情况下具有较低的失败率，我们开发了一种在其他可能失败的情况下将这些植入物用于这些肿瘤病例的技术。
在局部肿瘤刮除术后，使用大量螺钉将未固定的大型钽壳（有时带有钽增强物）固定在剩余的骨上。当存在大量内侧骨缺失时，将抗前突笼放置在杯的顶部，并固定在剩余的髂骨和坐骨上。
我们回顾性分析了 20 例采用描述技术治疗骨肿瘤破坏的髋关节置换术患者。他们的平均年龄为 60 岁（范围，22-80 岁）。我们记录了疼痛和活动状态、止痛药物的使用以及 Harris 髋关节评分。我们评估了随访 X 线片上的进行性透亮线和组件迁移。20 例患者中有 11 例在手术后平均 17 个月死亡。存活患者的最短随访时间为 26 个月（平均 56 个月；范围，26-85 个月）。
Harris 髋关节评分从术前的平均 32 分提高到术后的平均 74 分。我们没有观察到进行性透亮线或组件迁移的病例。并发症包括 1 例围手术期死亡、2 例浅表感染、1 例深静脉血栓形成和 1 例脱位。
我们的初步经验使钽重建成为我们处理主要髋臼周围肿瘤性骨缺失的首选方法。需要进行更多比较这种技术与其他替代方法的研究。
IV 级，治疗研究。有关证据水平的完整描述，请参见作者指南。
