Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere.
Department of Orthopaedics and Traumatology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
Acta Orthop. 2020 Jun;91(3):341-346. doi: 10.1080/17453674.2020.1732016. Epub 2020 Feb 28.
Background and purpose - The pelvis is the 3rd most common site of skeletal metastases. In some cases, periacetabular lesions require palliative surgical management. We investigated functional outcome, complications, and implant and patient survival after a modified Harrington's procedure.Patients and methods - This retrospective cohort study included 89 cases of surgically treated periacetabular metastases. All patients were treated with the modified Harrington's procedure including a restoration ring. Lesions were classified according to Harrington. Functional outcome was assessed by Harris Hip Score (HHS) and Oxford Hip Score (OHS). Postoperative complications, and implant and patient survival are reported.Results - The overall postoperative functional outcome was good to fair (OHS 37 and HHS 76). Sex, age, survival > 6 and 12 months, and diagnosis of the primary tumor affected functional outcome. Overall implant survival was 96% (95% Cl 88-100) at 1 year, 2 years, and 5 years; only 1 acetabular implant required revision. Median patient survival was 8 months (0-125). 10/89 patients had postoperative complications: 6 major complications, leading to revision surgery, and 4 minor complications.Interpretation - Our modified Harrington's procedure with a restoration ring to achieve stable fixation, constrained acetabular cup to prevent dislocation, and antegrade iliac screws to prevent cranial protrusion is a reliable reconstruction for periacetabular metastases and results in a good functional outcome in patients with prolonged survival. A standardized procedure and low complication rate encourage the use of this method for all Harrington class defects.
背景与目的 - 骨盆是骨骼转移的第 3 常见部位。在某些情况下，需要姑息性手术治疗髋臼周围病变。我们研究了改良哈林顿手术治疗髋臼周围转移瘤的功能结果、并发症以及植入物和患者的生存率。
患者和方法 - 这是一项回顾性队列研究，纳入了 89 例接受手术治疗的髋臼周围转移瘤患者。所有患者均接受改良哈林顿手术治疗，包括修复环。根据哈林顿分类对病变进行分类。采用 Harris 髋关节评分（HHS）和牛津髋关节评分（OHS）评估功能结果。报告术后并发症、植入物和患者生存率。
结果 - 整体术后功能结果为良好至一般（OHS 为 37，HHS 为 76）。性别、年龄、生存时间>6 个月和>12 个月以及原发性肿瘤的诊断影响功能结果。1 年、2 年和 5 年的总体植入物生存率为 96%（95%CI 88-100），仅 1 个髋臼植入物需要翻修。中位患者生存率为 8 个月（0-125）。89 例患者中有 10 例发生术后并发症：6 例严重并发症导致翻修手术，4 例轻微并发症。
结论 - 我们采用改良哈林顿手术治疗髋臼周围转移瘤，使用修复环实现稳定固定、使用约束性髋臼杯防止脱位以及使用顺行髂骨螺钉防止颅侧突出，这是一种可靠的重建方法，可获得良好的功能结果，且患者生存时间延长。标准化的手术程序和低并发症发生率鼓励对所有哈林顿缺陷类型使用这种方法。
