Shooroki Khalil Kargar, Khabiri Seyyed Saeed, Khodabakhshi Amirreza, Babaei Amirmohammad, Naghizadeh Hamed
Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran; Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Int J Surg Case Rep. 2025 Jun;131:111408. doi: 10.1016/j.ijscr.2025.111408. Epub 2025 May 7.
Metastatic involvement of the periacetabular region is a rare but functionally devastating complication of advanced malignancies. Structural insufficiency fractures in this area lead to severe pain, loss of ambulation, and impaired quality of life. Surgical reconstruction is challenging due to poor bone quality, complex anatomy, and often prior radiotherapy.
We report the case of a 36-year-old woman with a history of metastatic breast cancer who presented with acute right hip pain and inability to walk following a fall. Imaging revealed a metastatic insufficiency fracture of the right acetabulum involving the roof and both columns. The patient had a prior history of pelvic radiotherapy. A two-stage hybrid reconstruction was planned to optimize mechanical support while minimizing postoperative complications.
This case highlights the complexity of surgical decision-making in metastatic acetabular insufficiency. Various techniques exist, including cementoplasty, tripod fixation, Harrington reconstruction, 3D-printed implants, and pedestal prostheses. Each has unique advantages and limitations depending on lesion extent and patient factors. In our case, a staged hybrid approach (plate fixation, followed by Harrington + tripod + cemented THA) provided durable reconstruction without complications at 24 months follow-up.
Hybrid reconstruction offers a viable and effective option for managing complex metastatic periacetabular insufficiency fractures, particularly in previously irradiated patients. A multidisciplinary, staged strategy can achieve excellent functional outcomes with low complication rates.
髋臼周围区域的转移累及是晚期恶性肿瘤罕见但功能严重受损的并发症。该区域的结构性不全骨折会导致严重疼痛、行走能力丧失和生活质量下降。由于骨质质量差、解剖结构复杂且常接受过放疗，手术重建具有挑战性。
我们报告了一名36岁有转移性乳腺癌病史的女性病例，她因跌倒后出现急性右髋疼痛且无法行走。影像学检查显示右髋臼转移性不全骨折，累及髋臼顶和双侧髋臼柱。该患者既往有盆腔放疗史。计划进行两阶段混合重建，以优化机械支撑并减少术后并发症。
该病例突出了转移性髋臼不全手术决策的复杂性。存在多种技术，包括骨水泥成形术、三脚架固定、哈灵顿重建、3D打印植入物和基座假体。根据病变范围和患者因素，每种技术都有独特的优点和局限性。在我们的病例中，分阶段混合方法（钢板固定，随后进行哈灵顿 + 三脚架 + 骨水泥固定全髋关节置换术）在24个月的随访中提供了持久的重建且无并发症。
混合重建为处理复杂的转移性髋臼周围不全骨折提供了一种可行且有效的选择，尤其是对于既往接受过放疗的患者。多学科分阶段策略可实现良好的功能结果且并发症发生率低。
