From the Department of Orthopaedics and Rehabilitation (C.M.D., C.T., K.D.A., K.E.Y., I.K.I., D.M.L., G.E.F., F.Y.L.), Department of Radiology and Biomedical Imaging (E.R.B.), and Yale Center for Analytical Sciences (F.L., I.L.), Yale University School of Medicine, 47 College St, New Haven, CT 06520.
Radiology. 2023 May;307(3):e221401. doi: 10.1148/radiol.221401. Epub 2023 Mar 14.
Background Osteolytic neoplasms to periacetabular bone frequently cause pain and fractures. Immediate recovery is integral to lifesaving ambulatory oncologic care and maintaining quality of life. Yet, open acetabular reconstructive surgeries are associated with numerous complications that delay cancer treatments. Purpose To determine the effectiveness for short- and long-term pain and ambulatory function following percutaneous ablation, osteoplasty, reinforcement, and internal fixation (AORIF) for periacetabular osteolytic neoplasm. Materials and Methods This retrospective observational study evaluated clinical data from 50 patients (mean age, 65 years ± 14 [SD]; 25 men, 25 women) with osteolytic periacetabular metastases or myeloma. The primary outcome of combined pain and ambulatory function index score (range, 1 [bedbound] through 10 [normal ambulation]) was assessed before and after AORIF at 2 weeks and then every 3 months up to 40 months (overall median follow-up, 11 months [IQR, 4-14 months]). Secondary outcomes included Eastern Cooperative Oncology Group (ECOG) score, infection, transfusion, 30-day readmission, mortality, and conversion hip arthroplasty. Serial radiographs and CT images were obtained to assess the hip joint integrity. The paired test or Wilcoxon signed-rank test and Kaplan-Meier analysis were used to analyze data. Results Mean combined pain and ambulatory function index scores improved from 4.5 ± 2.4 to 7.8 ± 2.1 ( < .001) and median ECOG scores from 3 (IQR, 2-4) to 1 (IQR, 1-2) ( < .001) at the first 2 weeks after AORIF. Of 22 nonambulatory patients, 19 became ambulatory on their first post-AORIF visit. Pain and functional improvement were retained beyond 1 year, up to 40 months after AORIF in surviving patients. No hardware failures, surgical site infections, readmissions, or delays in care were identified following AORIF. Of 12 patients with protrusio acetabuli, one patient required a conversion hemiarthroplasty at 24 months. Conclusion The ablation, osteoplasty, reinforcement, and internal fixation, or AORIF, technique was effective for short- and long-term improvement of pain and ambulatory function in patients with periacetabular osteolytic neoplasm. © RSNA, 2023.
背景 累及髋臼周围骨的溶骨性肿瘤常引起疼痛和骨折。对于挽救生命的门诊肿瘤治疗和维持生活质量来说，快速康复至关重要。然而，开放式髋臼重建手术会引起许多并发症，从而延误癌症治疗。 目的 评估经皮消融、骨成形术、强化和内固定（AORIF）治疗髋臼周围溶骨性肿瘤的短期和长期疼痛及步行功能效果。 材料与方法 本回顾性观察性研究评估了 50 例（平均年龄，65 岁±14 岁[标准差]；25 例男性，25 例女性）髋臼周围溶骨性转移瘤或骨髓瘤患者的临床数据。主要结局指标为 AORIF 治疗前后 2 周及之后每 3 个月（总中位随访时间 11 个月[IQR，414 个月]）的联合疼痛和步行功能指数评分（范围，1[卧床不起]10[正常步行]）。次要结局指标包括东部肿瘤协作组（ECOG）评分、感染、输血、30 天再入院、死亡率和髋关节转换。连续进行髋关节 X 线和 CT 检查以评估髋关节完整性。采用配对 t 检验或 Wilcoxon 符号秩检验和 Kaplan-Meier 分析对数据进行分析。 结果 AORIF 治疗后 2 周内，联合疼痛和步行功能指数评分从 4.5±2.4 改善至 7.8±2.1（<.001），ECOG 评分中位数从 3（IQR，24）降至 1（IQR，12）（<.001）。22 例不能行走的患者中，19 例在 AORIF 后首次就诊时能够行走。在存活患者中，疼痛和功能改善在 AORIF 后 1 年甚至 40 个月时仍能维持。AORIF 后未发生内固定失败、手术部位感染、再入院或治疗延迟。12 例髋臼前突患者中，1 例在 24 个月时行半髋关节置换术。 结论 AORIF 技术对髋臼周围溶骨性肿瘤患者的短期和长期疼痛及步行功能改善均有效。 ©RSNA，2023 年。
