Fujiwara Tomohiro, Stevenson Jonathan, Parry Michael, Le Nail Louis-Romée, Tsuda Yusuke, Grimer Robert, Jeys Lee
Department of Oncology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK.
Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
Int J Clin Oncol. 2021 Jun;26(6):1139-1146. doi: 10.1007/s10147-021-01882-3. Epub 2021 Mar 15.
Acetabular reconstruction using an ice-cream cone prosthesis has been a reliable reconstruction option following pelvic tumour resection. However, it remains unknown which factor determines the success of this procedure. We aimed to determine risk factors for complications and functional loss in acetabular reconstruction using an ice-cream cone prosthesis.
Fifty-four patients with malignant bone tumours who underwent acetabular reconstruction using an ice-cream cone prosthesis between 2004 and 2016 were studied. The bone-stem ratio was calculated as the ratio of the inserted length into the bone per the entire stem length.
A total of 26 (48%) patients had at least one complication and 11 patients (20%) required surgical interventions. The complication rates were 71% and 40% with a bone-stem ratio ≤ 50% and > 50%, respectively (p = 0.026), and the bone-stem ratio significantly stratified the risk of complications (≤ 50%: OR, 4.67 versus > 50%; p = 0.048). The mean MSTS score at the final follow-up was 60% (range 23-97%): the scores were significantly lower in patients with complications/leg-length discrepancy (52%) than in those without (79%; p = 0.002). The mean score with a bone-stem ratio ≤ 50% was significantly lower than the score with a ratio > 50%, especially in patients who underwent non-navigated reconstructions (33% versus 64%; p = 0.001).
The inserted length of the coned stem into residual bone was predictive of complications and functional outcome. Surgical indication for this procedure should be considered with the size of the remaining ilium to stabilise the prosthesis with a coned stem longer than half length.
使用冰淇淋锥形假体进行髋臼重建一直是骨盆肿瘤切除术后可靠的重建选择。然而，尚不清楚哪个因素决定了该手术的成功。我们旨在确定使用冰淇淋锥形假体进行髋臼重建时并发症和功能丧失的危险因素。
研究了2004年至2016年间54例使用冰淇淋锥形假体进行髋臼重建的恶性骨肿瘤患者。骨柄比计算为插入骨内的长度与整个柄长度的比值。
共有26例（48%）患者至少发生一种并发症，11例（20%）患者需要手术干预。骨柄比≤50%和>50%时的并发症发生率分别为71%和40%（p = 0.026），骨柄比显著分层了并发症风险（≤50%：比值比，4.67对>50%；p = 0.048）。末次随访时的平均肌肉骨骼肿瘤学会（MSTS）评分为60%（范围23 - 97%）：有并发症/肢体长度差异的患者评分（52%）显著低于无并发症的患者（79%；p = 0.002）。骨柄比≤50%时的平均评分显著低于比值>50%时的评分，尤其是在未进行导航重建的患者中（33%对64%；p = 0.001）。
锥形柄插入残余骨的长度可预测并发症和功能结果。应根据剩余髂骨的大小考虑该手术的手术指征，以使用长度超过一半的锥形柄稳定假体。
