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[骨盆软骨肉瘤保肢切除术]

[Resection with preservation of the lower limb in chondrosarcoma of the pelvis].

作者信息

Guerra A, Briccoli A, Capanna R, Guernelli N, Picci P, Campanacci M

出版信息

Rev Chir Orthop Reparatrice Appar Mot. 1985;71(7):493-501.

PMID:4089264
Abstract

Twenty-seven chondrosarcomata of the pelvis were treated by local resection with preservation of the limb. Twenty-two were grade I or II, and 5 were grade III or IV. Attention is drawn to the importance of tomodensitometry in assessing the extent of the tumor before operation. An en bloc resection was well wide of the tumour in 16 cases, close to the tumour in 10 cases and involved the tumour in one case. Post-operative complications were varied. There were 6 nerve paralyses after iliac resection, 3 cases of sepsis after resection of the anterior part of the pelvic ring, and 3 cases of sepsis and 2 vascular complications after peri-acetabular resections. The average follow-up was 5 years. Three had metastases and three had local recurrences, one of whom died later from pulmonary metastases. No local recuRrence was seen in cases with wide resection. The functional results were satisfactory in 6 out of 7 partial resections of the ilium and in 4 out of 5 resections of the anterior part of the pelvic ring. They were only fair after peri-acetabular resections and complete resections of the ilium. After peri-acetabular resections, the results were about the same after ilio-femoral arthrodesis or Girdlestone operations. It is not appropriate to reconstruct the pelvic ring after resection limited to the anterior part of the pelvis but it is indicated after resections of the whole of the ilium, particularly in children to avoid shortening of the limb with pelvic shift.

摘要

27例骨盆软骨肉瘤采用保肢局部切除术治疗。其中22例为I级或II级,5例为III级或IV级。强调了术前计算机断层扫描在评估肿瘤范围方面的重要性。16例手术切缘距肿瘤较远,10例切缘靠近肿瘤,1例切缘累及肿瘤。术后并发症多样。髂骨切除术后有6例神经麻痹,骨盆环前部切除术后有3例脓毒症,髋臼周围切除术后有3例脓毒症和2例血管并发症。平均随访5年。3例出现转移,3例出现局部复发,其中1例后来死于肺转移。广泛切除的病例未见局部复发。7例部分髂骨切除中有6例功能结果满意,5例骨盆环前部切除中有4例功能结果满意。髋臼周围切除和全髂骨切除术后功能结果一般。髋臼周围切除术后,髂股关节融合术或Girdlestone手术的结果大致相同。局限于骨盆前部切除术后不宜重建骨盆环,但全髂骨切除术后则有必要重建,尤其是儿童患者,以避免肢体短缩和骨盆移位。

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