Osaka University Orthopaedic Oncology Group, Osaka, Japan,
Clin Orthop Relat Res. 2013 Mar;471(3):741-9. doi: 10.1007/s11999-012-2625-8.
Limb-salvage reconstruction for periacetabular malignant tumors is one of the most challenging problems in orthopaedic oncology. Reconstructive options include resection arthroplasty, endoprosthesis, allograft, recycled autobone graft, arthrodesis, and pseudarthrosis. However, no standard procedure exists because of rarity and clinical variability of the disease. We previously developed a megaprosthetic system with a constrained total hip mechanism (C-THA).
QUESTIONS/PURPOSES: We evaluated (1) survival of patients and C-THA; (2) postoperative function; and (3) complications.
We retrospectively reviewed 25 patients with primary periacetabular tumors treated using C-THA between 1985 and 2009. There were 18 male and seven female patients with a median age of 44 years (range, 16-72 years). They included 11 chondrosarcomas, eight osteosarcomas, two giant cell tumors of bone (one locally aggressive benign, one malignant), and others in four. Surgical margin was wide in 18 patients, marginal in five, and intralesional in two. The minimum postoperative followup for survivors was 32 months (median, 163 months; range, 32-285 months).
The 10-year overall survival rate of all patients was 47%. C-THA implants survived in 19 of 25 patients at last followup. Twenty-one patients acquired ambulatory activity. There were seven local recurrences, resulting in hemipelvectomy in one patient. Postoperative complications included deep infection in eight of the 25 patients, dislocation in four, and aseptic loosening in two, necessitating five revision surgeries and three implant removals.
Our observations suggest C-THA using an acetabular reconstruction cup is a useful reconstructive option after resection of periacetabular malignant tumors despite frequent postoperative complications.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
保肢重建术是治疗髋臼周围恶性肿瘤的最具挑战性的问题之一。重建选择包括关节切除成形术、假体、同种异体移植物、再循环自体骨移植物、融合术和假关节。然而，由于疾病的罕见性和临床变异性，目前还没有标准的程序。我们之前开发了一种带有约束性全髋关节机制（C-THA）的大型假体系统。
问题/目的：我们评估了（1）患者和 C-THA 的生存率；（2）术后功能；（3）并发症。
我们回顾性分析了 1985 年至 2009 年间采用 C-THA 治疗的 25 例原发性髋臼周围肿瘤患者。18 例为男性，7 例为女性，中位年龄为 44 岁（范围，16-72 岁）。其中包括 11 例软骨肉瘤、8 例骨肉瘤、2 例骨巨细胞瘤（1 例为局部侵袭性良性，1 例为恶性）和 4 例其他类型肿瘤。18 例患者的手术切缘为广泛，5 例为边缘，2 例为肿瘤内。所有幸存者的最低术后随访时间为 32 个月（中位数为 163 个月；范围，32-285 个月）。
所有患者的 10 年总生存率为 47%。在最后一次随访时，25 例患者中有 19 例 C-THA 植入物存活。21 例患者获得了活动能力。有 7 例局部复发，导致 1 例患者行半骨盆切除术。术后并发症包括 25 例患者中有 8 例深部感染、4 例脱位和 2 例无菌性松动，需要进行 5 次翻修手术和 3 次植入物取出。
尽管术后并发症频繁，但我们的观察表明，对于髋臼周围恶性肿瘤切除后，使用髋臼重建杯的 C-THA 是一种有用的重建选择。
IV 级，治疗性研究。有关证据水平的完整描述，请参见作者指南。
