Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
BMC Cancer. 2018 Oct 24;18(1):1036. doi: 10.1186/s12885-018-4971-8.
Difficult resection of tumors from regions with complex local anatomy, such as the pelvis and sacrum, is likely to result in inadequate surgical margins (intralesional or marginal); this is because three-dimensional osteotomy is difficult particularly around the acetabulum. Additionally, removal of the joint makes reconstruction very difficult; thus, retention of good function also becomes difficult. In musculoskeletal oncology, computer navigation systems are still not widely used to prevent tumor-positive margins. We performed wide excision with guidance from a computer navigation system and reconstruction using frozen bone autografts for malignant pelvic bone tumors in two patients, and we obtained excellent functional and oncological outcomes. Here we present these patients and discuss our approach.
Case 1: A 12-year-old girl presented with Ewing sarcoma of the left pelvis (PI-II). We performed wide excision assisted by a computer navigation system with the osteotomy of the load surface of acetabulum and reconstruction using a frozen bone autograft. At the final follow-up, she showed excellent function and was alive without the disease. Moreover, she did not have osteoarthritis of the left hip joint. Case 2: A 71-year-old woman presented with dedifferentiated chondrosarcoma of the right pelvis (PII-III). We performed wide excision assisted by a computer navigation system with osteotomy avoiding load surface of the acetabulum and reconstruction using a frozen bone autograft; there was no tumor at the load surface. At the final follow-up, she showed good function, was alive without the disease, and did not have osteoarthritis of the left hip joint.
Wide excision assisted by a computer navigation system and reconstruction using a frozen bone autograft are very useful for the management/treatment of extremely difficult cases such as malignant pelvic bone tumors, particularly those including the acetabulum.
在骨盆和骶骨等解剖结构复杂的区域，肿瘤切除困难，可能导致手术切缘不足（腔内或边缘性）；这是因为在髋臼周围进行三维截骨尤其困难。此外，关节切除使重建非常困难；因此，保留良好的功能也变得困难。在肌肉骨骼肿瘤学中，计算机导航系统仍未广泛用于防止肿瘤阳性切缘。我们为 2 例恶性骨盆骨肿瘤患者在计算机导航系统的引导下进行广泛切除，并使用冷冻骨自体移植物进行重建，获得了良好的功能和肿瘤学结果。在此，我们介绍这 2 例患者并讨论我们的方法。
病例 1：一名 12 岁女孩因左骨盆尤文肉瘤就诊（PI-II）。我们在计算机导航系统的辅助下进行广泛切除，包括髋臼负重面的截骨和冷冻骨自体移植物重建。最终随访时，患者功能良好，无疾病存活，且左侧髋关节无骨关节炎。病例 2：一名 71 岁女性因右骨盆去分化软骨肉瘤就诊（PII-III）。我们在计算机导航系统的辅助下进行广泛切除，避免髋臼负重面的截骨和冷冻骨自体移植物重建；髋臼负重面没有肿瘤。最终随访时，患者功能良好，无疾病存活，且左侧髋关节无骨关节炎。
计算机导航系统辅助广泛切除和冷冻骨自体移植物重建对于处理恶性骨盆骨肿瘤等极其困难的病例非常有用，特别是包括髋臼在内的病例。
