Department of Orthopaedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
J Surg Oncol. 2021 Apr;123(5):1316-1327. doi: 10.1002/jso.26409. Epub 2021 Feb 1.
Symptomatic peri-acetabular metastatic lesions are often treated with open surgery such as modified Harrington procedures. In an effort to avoid surgical complications inherently associated with open surgical approaches, we developed and recently reported a novel Tripod percutaneous screw technique. The tripod technique is minimally invasive and was found to yield excellent outcomes regarding both pain control and functionality. The procedure is performed in a standard operative theater using fluoroscopic guided percutaneous screws. Despite the simplicity of intraoperative set-up and instrumentation, it is technically demanding. Obtaining the correct fluoroscopic views and troubleshooting intraoperative hurdles can be challenging for even an experienced orthopedic surgeon. The technique and bony conduits were previously described in the trauma literature, however, there are key points of difference in the setting of metastatic disease. Here we provide a compilation of a stepwise graphic guide for the tripod model in the setting of metastatic peri-acetabular lesions, as well as the tips and tricks based on our own experience. These encompass preoperative preparation, operating room settings, intraoperative fluoroscopic guidance, postoperative care, and subsequent conversion to a cemented total hip arthroplasty, if needed.
有症状的髋臼周围转移性病变常采用开放式手术治疗，如改良哈林顿手术。为了避免开放式手术固有的手术并发症，我们开发并最近报道了一种新的三脚经皮螺钉技术。三脚技术微创，在疼痛控制和功能方面均取得了优异的效果。该手术在标准手术室中通过透视引导下经皮螺钉完成。尽管术中设置和器械简单，但技术要求很高。即使是经验丰富的骨科医生，获得正确的透视视图和解决术中障碍也具有挑战性。该技术和骨通道以前在创伤文献中已有描述，但在转移性疾病的情况下存在关键差异。在这里，我们提供了一个分步图形指南，用于转移性髋臼周围病变的三脚模型，以及根据我们自己的经验总结的技巧和窍门。这些内容包括术前准备、手术室设置、术中透视引导、术后护理以及随后根据需要转换为骨水泥全髋关节置换术。
