DiCaprio Matthew, Ippolito Joseph A, Benevenia Joseph
Instr Course Lect. 2019;68:593-606.
Management of a painful metastatic acetabular lesion is complex and requires the assessment of tumor size and location, remaining integrity of the acetabulum, analgesic requirements, ability to use postoperative radiation, and projected patient survival. Patients presenting with suspected periacetabular metastasis frequently have groin pain aggravated by weight bearing. After a complete physical examination, advanced imaging and a complete laboratory workup should be performed to assess the extent of local and systemic disease. If a patient has a previously identified metastatic lesion, it is beneficial to communicate with the patient's medical oncologist to gather information on responses to chemotherapeutic agents, hormonal agents, and radiation therapy. Management may be nonsurgical, interventional, or surgical. Despite the limited life expectancy of patients with periacetabular metastasis, when performed in the appropriate setting, reconstruction by using anti-protrusio cages, screws, and cemented hip arthroplasty can improve quality of life by aiding independent ambulation and decreasing pain.
疼痛性髋臼转移瘤的治疗很复杂，需要评估肿瘤大小和位置、髋臼剩余完整性、镇痛需求、术后放疗的适用性以及患者预计生存期。疑似髋臼周围转移的患者常出现负重时加重的腹股沟疼痛。全面体格检查后，应进行高级影像学检查和完整的实验室检查，以评估局部和全身疾病的程度。如果患者之前已确诊有转移瘤，与患者的肿瘤内科医生沟通以收集有关化疗药物、激素药物和放疗反应的信息会很有帮助。治疗方法可以是非手术、介入或手术治疗。尽管髋臼周围转移患者预期寿命有限，但在合适的情况下进行治疗时，使用防髋臼内陷笼、螺钉和骨水泥型髋关节置换术进行重建可通过帮助患者独立行走和减轻疼痛来提高生活质量。
