Anract Philippe, Biau David, Babinet Antoine, Tomeno Bernard
Service de chirurgie orthopédique et oncologique, Hôpital Cochin, AP-HP Université Paris-Descartes, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
Bull Cancer. 2014 Feb;101(2):184-94. doi: 10.1684/bdc.2014.1884.
The three more frequent primitive malignant bone tumour which concerned the iliac bone are chondrosarcoma, following Ewing sarcoma and osteosarcoma. Wide resection remains the most important part of the treatment associated with chemotherapy for osteosarcoma and the Ewing sarcoma. Iliac wing resections and obdurate ring don't required reconstruction. However, acetabular resections and iliac wing resection with disruption of the pelvic ring required reconstruction to provide acceptable functional result. Acetabular reconstruction remains high technical demanding challenge. After isolated acetabular resection or associated to obdurate ring, our usual method of reconstruction is homolateral proximal femoral autograft and total hip prosthesis but it is possible to also used : saddle prosthesis, Mac Minn prosthesis with auto or allograft, modular prosthesis or custom made prosthesis, massive allograft with or without prosthesis and femoro-ilac arthrodesis. After resection of the iliac wing plus acetabulum, reconstruction can be performed by femoro-obturatrice and femora-sacral arthrodesis, homolateral proximal femoral autograft and prosthesis, femoral medialisation, massive allograft and massive allograft. Carcinological results are lesser than resection for distal limb tumor, local recurrence rate range 17 to 45%. Functional results after Iliac wing and obdurate ring are good. However, acetabular reconstruction provide uncertain functional results. The lesser results arrive after hemipelvic or acetabular and iliac wing resection-reconstruction, especially when gluteus muscles were also resected. The most favourable results arrive after isolated acetabular or acetabular plus obturateur ring resection-reconstruction.
累及髂骨的三种较常见的原发性恶性骨肿瘤依次为软骨肉瘤、尤因肉瘤和骨肉瘤。广泛切除仍然是骨肉瘤和尤因肉瘤治疗中与化疗相关的最重要部分。髂骨翼切除和骨盆环完整时不需要重建。然而,髋臼切除以及伴有骨盆环破坏的髂骨翼切除需要进行重建以获得可接受的功能结果。髋臼重建仍然是一项技术要求很高的挑战。在孤立的髋臼切除或与骨盆环完整相关的情况下,我们常用的重建方法是同侧近端股骨自体骨移植和全髋关节假体,但也可以使用:鞍形假体、带自体或异体骨的麦克明假体、模块化假体或定制假体、带或不带假体的大块异体骨以及股骨-髂骨融合术。在切除髂骨翼加髋臼后,可通过股骨-闭孔和股骨-骶骨融合术、同侧近端股骨自体骨移植和假体、股骨内移、大块异体骨和大块异体骨进行重建。肿瘤学结果不如肢体远端肿瘤切除,局部复发率在17%至45%之间。髂骨翼和骨盆环完整切除后的功能结果良好。然而,髋臼重建的功能结果不确定。半骨盆或髋臼及髂骨翼切除重建后的结果较差,尤其是当臀肌也被切除时。孤立髋臼或髋臼加闭孔环切除重建后的结果最理想。