Department of Orthopaedic Surgery, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT, 06030, USA.
Arch Orthop Trauma Surg. 2023 Jun;143(6):3517-3524. doi: 10.1007/s00402-022-04589-w. Epub 2022 Aug 19.
Radiation therapy is a common primary, adjuvant, or palliative treatment for many intrapelvic tumors, including primary gastrointestinal, genitourinary, and hematopoietic tumors, as well as metastatic disease to bone. Radiation has well documented microbiologic and clinical effects on bone ranging from radiation osteitis to early degenerative changes of the hip joint and avascular necrosis of the femoral head. Conventional total hip arthroplasty methods have demonstrated high rates of failure in this population, with historical data describing aseptic loosening rates as high as 44-52%, as radiation have been shown to preferentially diminish osteoblast and osteocyte number and function and limit capacity for both cement interdigitation and biologic bony ingrowth. A review of the clinical literature suggests that patients with prior pelvic irradiation are at higher risk for both septic and aseptic loosening of acetabular components, as well as lower postoperative Harris Hip Score (HHS) when compared to historical controls. With limited evidence, trabecular metal shells with multi-screw fixation and cemented polyethene liners, as well as cemented cup-cage constructs both appear to be durable acetabular fixation options, though the indications for each remains elusive. Further prospective data are needed to better characterize this difficult clinical problem.
放射治疗是许多盆腔内肿瘤的常见主要、辅助或姑息治疗方法，包括原发性胃肠道、泌尿生殖和血液系统肿瘤以及骨转移疾病。放射治疗对骨骼具有良好的微生物学和临床效应，从放射骨炎到髋关节早期退行性变和股骨头无菌性坏死。在这种人群中，传统的全髋关节置换方法已证明失败率很高，历史数据描述的无菌性松动率高达 44-52%，因为放射治疗已被证明会优先减少成骨细胞和骨细胞的数量和功能，并限制水泥交织和生物骨内生长的能力。对临床文献的回顾表明，与历史对照相比，既往盆腔放疗的患者发生髋臼部件感染性和无菌性松动的风险更高，术后 Harris 髋关节评分（HHS）更低。证据有限，多螺钉固定的小梁金属外壳和骨水泥聚乙烯衬垫，以及骨水泥杯笼结构似乎都是耐用的髋臼固定选择，尽管每种方法的适应证仍不明确。需要进一步的前瞻性数据来更好地描述这一困难的临床问题。
