Department of Orthopedics, West China Hospital, No. 37 Guoxue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
Department of Orthopedics, The Third Hospital of Mianyang, No. 190 The East Jiannan Road, Mianyang, 621000, Sichuan, People's Republic of China.
World J Surg Oncol. 2017 Nov 13;15(1):200. doi: 10.1186/s12957-017-1269-2.
The management of pelvic giant cell tumors (GCTs) involving the acetabulum remains a challenge for surgeons on how to balance the relative benefits of minimizing recurrence and maintaining postoperative hip function. The present study was to present and evaluate the clinical indications, operative technique, and outcomes of pelvic GCTs involving partial acetabulum treated with multiplanar osteotomy and reconstruction of autogenous femoral head bone grafts combined with cementless total hip arthroplasty (THA).
We retrospectively reviewed seven patients with pelvic GCTs involving partial acetabulum who underwent multiplanar osteotomy and reconstruction of autogenous femoral head bone grafts combined with cementless THA from January 2010 to October 2014. We assess the outcome including the bone graft healing, nonunion, hardware failure, infection, tumor recurrence, and metastasis. And the functional outcome was evaluated by the Musculoskeletal Tumor Society (MSTS)93 score.
All patients were followed up for a mean of 38.1 months (range 26-61 months). All bone grafts are union. No failure of acetabular components, wound healing problem, or deep infection was suspected. No patient experienced metastasis. Recurrence was observed in one out of seven patients, treated by extended resection and implanting iodine ions in the surgical area. The mean MSTS93 score was 29.4 (range 28-30). All patients were disease-free and resumed activities of daily living at the most recent follow-up.
As long as one of the two columns is retained and the resulting defect does not exceed the supra-acetabular line, multiplanar osteotomy and reconstruction of autogenous femoral head bone grafts combined with cementless THA is a viable strategy for the treatment of pelvic GCTs involving partial acetabulum. However, a large-scale prospective clinical study is still needed to verify these procedures.
对于外科医生来说，如何平衡最大限度减少复发和维持术后髋关节功能之间的相对益处，仍然是处理累及髋臼的骨盆巨大细胞瘤（GCT）的挑战。本研究旨在介绍和评估采用多平面截骨和自体股骨头骨移植物重建联合非骨水泥全髋关节置换术（THA）治疗累及部分髋臼的骨盆 GCT 的临床适应证、手术技术和结果。
我们回顾性分析了 2010 年 1 月至 2014 年 10 月期间采用多平面截骨和自体股骨头骨移植物重建联合非骨水泥 THA 治疗的 7 例累及部分髋臼的骨盆 GCT 患者。我们评估了包括植骨愈合、骨不连、内固定失败、感染、肿瘤复发和转移等结果。并采用肌肉骨骼肿瘤学会（MSTS）93 评分评估功能结果。
所有患者平均随访 38.1 个月（范围 26-61 个月）。所有植骨均愈合。无髋臼部件失败、伤口愈合问题或深部感染。无患者发生转移。7 例患者中有 1 例复发，经扩大切除和在手术区域植入碘离子治疗。MSTS93 评分平均为 29.4（范围 28-30）。所有患者均无疾病，在最近的随访中恢复了日常生活活动。
只要保留两个柱中的一个，且由此产生的缺损不超过髋臼上方线，多平面截骨和自体股骨头骨移植物重建联合非骨水泥 THA 是治疗累及部分髋臼的骨盆 GCT 的可行策略。然而，仍需要进行大规模的前瞻性临床研究来验证这些手术。
