Issa Samir-Pierre, Biau David, Babinet Antoine, Dumaine Valérie, Le Hanneur Malo, Anract Philippe
Department of Orthopedic Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), 27 rue du Faubourg Saint Jacques, 75014, Paris, France.
Paris-Descartes University, Sorbonne Paris Cité, Paris, France.
Int Orthop. 2018 Aug;42(8):1987-1997. doi: 10.1007/s00264-018-3785-2. Epub 2018 Jan 27.
Despite numerous reconstructive techniques and prosthetic devices, pelvic reconstructions following peri-acetabular malignant tumours resections are highly challenging. In the present study, we describe our experience with the Integra® (Lépine, Genay, France) ice-cream cone prosthesis in such indications. The objective was to assess the mid-term outcomes of this device.
Twenty-four patients' chart with peri-acetabular malignant tumours, who underwent types II or II + III peri-acetabular resections according to Enneking and Dunham with subsequent reconstruction using the Integra® prosthesis between February 2009 and February 2015, were reviewed. Seventeen cases were primary surgeries and seven cases were revisions (i.e., failures of previous reconstructions for pelvic tumours). All living patients with the prosthesis implanted were functionally assessed, using the musculoskeletal tumour society (MSTS) and Postel-Merle d'Aubigné (PMA) scores.
After a mean follow-up of 49 ± 26 months (range, 8 to 94 months), 21 patients were alive (88%), including 15 patients continuously disease-free (63%). MSTS and PMA scores averaged 72 ± 13% (range, 43 to 87%) and 14.6 ± 2.6 (range, 9 to 18), respectively. Fourteen patients (58%) presented at least one complication during follow-up, including four cases of deep infection (17%), four cases of dislocation (17%), and two mechanical failures (8%). At 5 years, the implant survival rate was 75%.
In comparison to previous reconstructive techniques that we used in similar indications, functional and oncologic outcomes were improved with the Integra® implant. However, as commonly observed in pelvic bone tumour surgery, complication rates remain significant.
Therapeutic, Level IV-Retrospective Cases Series.
尽管有众多重建技术和假体装置，但髋臼周围恶性肿瘤切除术后的骨盆重建极具挑战性。在本研究中，我们描述了我们在这类适应症中使用Integra®（法国热奈市勒皮纳公司）冰淇淋筒假体的经验。目的是评估该装置的中期结果。
回顾了2009年2月至2015年2月期间24例髋臼周围恶性肿瘤患者的病历，这些患者根据恩内金和邓纳姆分类法接受了II型或II + III型髋臼周围切除术，随后使用Integra®假体进行重建。其中17例为初次手术，7例为翻修手术（即先前骨盆肿瘤重建失败）。对所有植入假体的存活患者进行功能评估，采用肌肉骨骼肿瘤学会（MSTS）和波斯特尔-梅尔·德奥比涅（PMA）评分。
平均随访49±26个月（范围8至94个月）后，21例患者存活（88%），其中15例患者持续无病（63%）。MSTS和PMA评分平均分别为72±13%（范围43至87%）和14.6±2.6（范围9至18）。14例患者（58%）在随访期间出现至少一种并发症，包括4例深部感染（17%）、4例脱位（17%）和2例机械故障（8%）。5年时，植入物存活率为75%。
与我们在类似适应症中使用的先前重建技术相比，Integra®植入物改善了功能和肿瘤学结果。然而，正如骨盆骨肿瘤手术中常见的那样，并发症发生率仍然很高。
治疗性，IV级——回顾性病例系列。
