Lee Seung Yong, Jeon Dae-Geun, Cho Wan Hyeong, Song Won Seok, Kong Chang-Bae
Department of Orthopedic Surgery, Korea Cancer Center Hospital, Seoul, Korea.
Clin Orthop Surg. 2017 Sep;9(3):374-385. doi: 10.4055/cios.2017.9.3.374. Epub 2017 Aug 4.
Because of the high complication rate of anatomical reconstruction after periacetabular resection, the strategy of resection alone has been revisited. However, in terms of complications and functional outcome, whether resection hip arthroplasty (RHA) shows a superior result to that of pelvic ring reconstruction remains controversial.
We compared 24 RHAs and 16 pasteurized autograft-prosthesis composite (PPC) reconstructions regarding the complication rates, operative time, blood loss, and functional outcome.
Compared to 16 PPC hips, 24 RHA hips showed lower major and minor complication rates ( < 0.001), shorter surgical time ( < 0.001), and superior Musculoskeletal Tumor Society scores ( < 0.001). Of the 24 RHA hips, bony neo-acetabulum was identified in 7 on computed tomography and partial neo-acetabulum in 9; the remaining 8 had no bony acetabular structure. The average time to bony neo-acetabulum formation was 7 months (range, 4 to 13 months).
RHA for periacetabular tumors can be an excellent alternative to anatomical reconstruction. It offers short surgical time, low complication rates, and functional results comparable to those of other reconstruction methods. However, this procedure is indicated for patients who can accept some limb shortening, and a tumor should be confined to the periacetabular area.
由于髋臼周围切除术后解剖重建的并发症发生率较高，单纯切除策略再次受到关注。然而，就并发症和功能结果而言，切除性髋关节置换术（RHA）是否比骨盆环重建术有更好的效果仍存在争议。
我们比较了24例RHA和16例经巴氏消毒的自体移植假体复合物（PPC）重建术在并发症发生率、手术时间、失血量和功能结果方面的差异。
与16例PPC髋关节相比，24例RHA髋关节的主要和次要并发症发生率更低（<0.001），手术时间更短（<0.001），肌肉骨骼肿瘤学会评分更高（<0.001）。在24例RHA髋关节中，计算机断层扫描显示7例有骨性新髋臼，9例有部分新髋臼；其余8例无骨性髋臼结构。骨性新髋臼形成的平均时间为7个月（范围4至13个月）。
髋臼周围肿瘤的RHA可以是解剖重建的一种极佳替代方法。它手术时间短，并发症发生率低，功能结果与其他重建方法相当。然而，该手术适用于能够接受一定肢体短缩的患者，且肿瘤应局限于髋臼周围区域。
