股骨近端上移重建骨盆肿瘤切除后的骨缺损

 目的 总结以股骨近端上移重建骨盆肿瘤切除后骨缺损的手术技术要点,探讨其手术适应证。方法 自2006年10月至2011年5月,对5例骨盆恶性肿瘤患者采用同侧股骨近端截骨上移重建骨盆环连续性、肿瘤型人工关节假体重建髋关节,男3例,女2例;年龄19~55岁,平均30.6岁。软骨肉瘤3例、原始神经外胚层瘤2例。3例肿瘤累及骨盆Ⅰ+Ⅱ区,2例累及Ⅱ+Ⅲ区。所有患者均获得随访,统计并发症发生情况,采用国际骨肿瘤协会(Musculoskeletal Tumor Society, MSTS)功能评分评价患肢功能,评价肿瘤学预后。结果 至末次随访时5例患者中1例死亡,1例带瘤生存,其余3例无瘤生存。主要并发症包括肿瘤局部复发、假体松动、植骨不愈合、浅表感染、坐骨神经麻痹。1例患者术后15个月发生植骨不愈合,内固定松动,可扶拐行走。1例患者因假体松动,术后26个月行翻修手术。1例患者术后6个月肿瘤局部复发改行截肢手术;1例术后18个月局部复发,未进一步处理带瘤生存。MSTS评分为11~25分,平均19.2分。结论 同侧股骨近端上移重建骨盆肿瘤切除后的骨缺损是一种有效重建骨盆连续性的方法,既适用于骨盆Ⅱ+Ⅲ区缺损,也适用于骨盆Ⅰ+Ⅱ区缺损。但此术式仍具有较高的并发症发生率,其近期效果与骨盆假体类似,远期疗效有待于进一步观察。     

计算机导航辅助髋臼肿瘤精确切除与重建

目的 探索髋臼恶性肿瘤精确切除与重建的有效方法,评价其临床治疗效果.方法 利用图像融合、逆向工程、计算机辅助设计与制造等技术,建立髋臼恶性肿瘤精确切除与重建的治疗流程,完成术前规划并制备个体化定制髋臼假体,利用计算机导航系统辅助手术实施,实现肿瘤的精确切除及假体安装.自2010年12月至2012年5月,采用该流程治疗3例髋臼恶性肿瘤患者,软骨肉瘤2例、原始神经外胚层肿瘤1例,均累及骨盆Ⅱ+Ⅲ区.采用国际骨肿瘤协会(Musculoskeletal Tumor Society,MSTS)功能评分评价患肢功能,统计并发症发生情况.结果 3例患者均成功获得精确的肿瘤切除与髋臼重建.1例患者术后因搬动失误发生髋关节脱位,予以闭合复位;该例患者术后出现下肢深静脉血栓形成,对症治疗后治愈.术后3例患者均获得随访,随访时间10～21个月.至末次随访时3例患者均无瘤生存,未见感染、假体松动、螺钉断裂等并发症.MSTS评分为18～26分.结论 计算机导航辅助肿瘤切除和个体化定制髋臼假体重建能够满足髋臼肿瘤精确切除和重建的要求,肿瘤切除彻底、髋臼重建满意、并发症发生率低、近期效果良好,是外科治疗恶性髋臼肿瘤的一种有效方法,其远期疗效有待于进一步观察.     

累及骶骨的骨盆恶性肿瘤切除及重建

目的 探讨累及骶骨的骨盆恶性肿瘤合理的手术切除及重建方式.方法 1999年7月至2007年7月,共有19例累及骶骨的骨盆恶性肿瘤患者在北京大学人民医院骨肿瘤科接受肿瘤切除重建手术.平均年龄37岁(12～78岁);男性12例,女性7例. 其中,软骨肉瘤5例、尤文肉瘤4例、骨肉瘤4例、恶性纤维组织细胞瘤(MFH)1例、骨巨细胞瘤1例、转移癌4例.切除髂骨翼及部分骶骨、保留髋臼手术10例,采用了钉棒系统内固定,其中5例患者同时进行了自体腓骨或髂骨植骨;切除部分骶骨、髂骨翼及髋臼手术9例,应用组配式人工半骨盆重建骨盆环完整性.结果 肿瘤学结果:7例出现局部复发(7/19,36.9%),其中骨肉瘤2例、软骨肉瘤2例、尤文肉瘤2例及转移癌1例.19例患者随访时间为1至7年,平均4.5年.功能结果:9例保留髋臼、钉棒重建的患者术后正常行走,无步态异常.9例行Ⅱ区肿瘤切除、人工半骨盆重建的患者中,8例术后2个月能够扶拐行走.ISOLS评分平均20分以上,其中,良好3例,一般5例,较差1例.人工半骨盆重建的患者中,术后脱位1例,行切开复位;因深部感染取出假体1例.结论 对于保留髋臼的髂骨肿瘤切除,采用钉棒内固定结合自体骨植骨是一种理想的重建骨盆环稳定性的方法,可使患者早期恢复行走功能.将股骨头颈植于骶骨侧方,将组配式人工半骨盆卡于质骨块的下方,重建累及骶骨及髋臼的骨盆切除,是一种可取的重建方式.     

Percutaneous implantation of subcutaneous prosthetic ureters: long-term outcome

PURPOSE: We have used an extra-anatomic subcutaneous alloplastic ureteral replacement initially to bypass ureteral obstruction secondary to advanced pelvic malignancies in patients with a short life expectancy. Following the encouraging preliminary results, our list of indications has broadened to include complex benign ureteral strictures. We herein report the long-term outcome. PATIENTS AND METHODS: A series of 35 subcutaneous prosthetic ureters were implanted percutaneously in 27 patients (19 unilateral and 8 bilateral) to bypass extrinsic ureteral obstructions. The nature of obstruction was neoplastic in 22 patients and benign in 5. A composite prosthesis, consisting of two coaxial tubes--internal pure smooth silicone covered by coiled e-PTFE--has been designed to serve as the ureteral replacement. This tube is inserted percutaneously into the renal pelvis, tunnelled subcutaneously, and introduced through a small suprapubic incision in the bladder. All patients were followed to date or until death from tumor. The mean follow-up was 6.3 months for the deceased patients and 47 months for the surviving ones, the longest follow-up being 84 months. RESULTS: No operative or immediate postoperative deaths were observed. Initial difficulty in placing the prosthesis was encountered in 5 of the 27 patients (19%). Secondary parietal complications occurred in 8.5% of cases (3/35). The prosthetic ureter had to be removed in one patient because of skin erosion. Return to a standard percutaneous nephrostomy was needed in two patients because of local tumor progression with bladder fistulae. Five patients are alive with the prosthesis in place and a follow-up as long as 84 months without encrustation, infection, obstruction, or skin problems and with normally functioning kidneys. CONCLUSION: The subcutaneous urinary diversion using a silicone-PTFE prosthesis is an efficient and minimally invasive way to bypass malignant or complex benign obstructions of the ureters that otherwise would necessitate permanent nephrostomy drainage.     

定制型节段假体重建长骨骨干转移瘤骨缺损

目的探讨定制型节段假体重建治疗长骨骨干转移瘤骨缺损的临床效果。方法应用定制型节段假体重建治疗15例长骨骨干转移瘤骨缺损患者。采用Kaplan-Meier法计算患者生存率,NRS评分评估术后疼痛,MSTS 93评分系统评估术后肢体功能。结果8例存活,随访时间16~56(29.75±13.20)个月;7例死亡,随访时间12~44(23.86±12.24)个月。术后1年患者总生存率93.3%,术后2年患者总生存率73.3%。假体在体时间12~56(27.00±13.10)个月,假体长度6~13(9.73±2.15)cm。术后3个月MSTS评分24~29(26.87±1.55)分。NRS评分术前4~8(6.20±1.15)分,术后1个月0~1(0.20±0.40)分,差异有统计学意义(P<0.05)。1例肱骨转移瘤患者术后6个月复查出现影像学无菌性松动,未明显影响上肢功能。结论定制型节段假体重建长骨骨干转移瘤骨缺损具有缓解疼痛明显、允许早期负重及功能锻炼、保留较好肢体功能、术后并发症发生率较低等优势。     

髋臼周围恶性肿瘤的外科治疗

目的 探讨髋臼周围恶性肿瘤保肢手术的方法和疗效.方法 回顾性分析1999年1月至2006年12月行保肢手术的31例髋臼周围恶性肿瘤患者的临床资料.其中男性17例,女性14例;年龄42～75岁,平均53岁.软骨肉瘤24例、尤文肉瘤4例、骨肉瘤1例、转移性肿瘤2例.Ⅱ区切除16例,Ⅰ+Ⅱ区切除5例,Ⅱ+Ⅲ区切除5例,Ⅰ+Ⅱ+Ⅲ区切除5例.肿瘤切除后重建17例,未重建14例.结果 31例患者随访时间12～84个月,平均52个月.14例患者无瘤生存,4例带瘤生存,13例死亡.软骨肉瘤的复发率为20.8%,死亡率33.3%.2例转移性肿瘤患者广泛转移,死于术后11和34个月.1例骨肉瘤和2例尤文肉瘤患者死于肺转移.采用Enneking骨肿瘤术后患者的功能评估方法,18例存活的患者参加功能评价.13例切除后重建的患者中优6例、良好6例、差1例.6例未重建患者优3例、良好2例、差1例.6例患者术后出现可控性并发症.结论 广泛切除肿瘤降低局部复发率是围髋臼肿瘤保肢手术的基本要求,重建髋关节的功能应综合考虑肿瘤破坏的范围和手术切除的范围,遵循个体化原则.     

Isolated mitral valve replacement with the Bj?rk-Shiley prosthesis in 100 consecutive patients. Short- and long-term results

Single mitral valve replacement with the Bj?rk-Shiley tilting disc prosthesis was performed in 100 consecutive patients between March 1971 and December 1973. The hospital mortality was 13% and the late mortality was 6%. 74 of the patients were followed for periods ranging between 12 and 46 months (mean follow-up: 24 months): clinical improvement was noted in 92%. The incidence of postoperative embolism, including 1 case of prosthesis thrombosis, was 6.7%, and all cases occurred within the first 9 months after surgery. 6 patients required reoperation because of prosthesis dysfunction due to thrombosis (1 patient), leakage (3), and late disc entrapment (2).     

Prosthetic reconstruction for tumors of the distal tibia. Report of two cases

Prosthetic reconstruction in two patients with malignant bone tumors of the distal tibia was conducted. The diagnoses were metastatic bone tumor in one patient and low grade central osteosarcoma in another. The mean duration of follow-up was 5.5 years (3 and 8 years). Reconstruction was achieved using custom-made prosthesis (JMM, Japan Medical Materials), which replaced the distal tibia. In the patient with metastasis, local recurrence occurred 8 months after the primary surgery and the recurrent tumor was resected. Both patients were free from neoplastic disease at the latest follow-up. The average functional scores according to the system of the Musculoskeletal Tumor Society were 25 and 23. Custom-made prostheses allow an early return to functional weight-bearing without major complications. This technique provides a safe and effective method of stabilization for properly selected malignant tumors of the distal tibia.     

Implantation of hemipelvic prosthesis after resection of sarcoma

Twelve adult patients with pelvic sarcoma had implantation of a hemipelvic prosthesis. Eight patients had hemipelvic resection, and four patients had acetabulopubic resection. The implanted prosthesis was a special Vitallium prosthesis, which was specially designed for each patient with the aid of a computer. At a median followup of 57 months, eight patients were free of disease. In four patients with local relapse, two had additional resection, one had hindquarter amputation, and one was observed. In three patients with deep infection, the prosthesis was removed; however, one patient had hindquarter amputation. One patient had dislocation of the hip and prosthesis loosening. Overall survival of patients was 70%, and the survival of prostheses was 42%. In eight patients, the functional evaluation showed that the average functional score with the prosthesis was 11.6 (39%) and without the prosthesis the functional score was 7.0 (23%). Implantation of a megaprosthesis seems to indicate a high complication rate and a poor functional result after hemipelvic resection.     

Tikhoff-Linberg procedure for bone and soft tissue tumors of the shoulder girdle

OBJECTIVE: To evaluate complications and the oncological and intermediate-term functional results in patients with bone and soft tissue tumors of the shoulder girdle who were managed with interscapulothoracic resection (Tikhoff-Linberg procedure). DESIGN: Case series of 19 consecutive patients during a 10-year period at a mean follow-up of 6.3 years (range, 1-11 years). SETTING: University hospital; referral center for musculoskeletal tumor surgery. PATIENTS: The initial diagnosis in this consecutive series of patients with shoulder girdle tumors requiring the Tikhoff-Linberg procedure was chondrosarcoma in 7 patients, Ewing sarcoma in 3 patients, malignant fibrous histiocytoma in 3 patients, solitary metastasis of thyroid carcinoma in 2 patients, osteosarcoma, synovial sarcoma, angiosarcoma, ancd neurofibrosarcoma in 1 patient each. According to the Musculoskeletal Tumor Society staging system, there were 6 in surgical stage IB, 10 in stage IIB, and 3 in stage III. Nine tumors involved the proximal humerus, 8 were located in the scapula or surrounding soft tissues, 1 in the lateral clavicle, and 1 in the acromioclavicular joint. INTERVENTIONS: For reconstruction of the proximal humerus after en bloc tumor resection an isoelastic cemented shoulder tumor prosthesis was inserted in every patient to restore arm length. MAIN OUTCOME MEASURES: Complications, and oncological and intermediate-term functional results. RESULTS: Twelve patients were alive with no evidence of disease. One of these patients died of nontumorous disease 2 years after surgery. One patient is alive with pulmonary metastases after 12 months. Six patients died of metastases at a mean (SD) interval of 18 months (range, 3-35 months) postoperatively. Two of these patients had additional local recurrence. A deep infection necessitated the explantation of the prosthesis in 1 patient. The mean functional score and SD according to the rating system of the Musculoskeletal Tumor Society was 72%+/-14% (range, 33%-87%) for the 12 surviving patients evaluated. Major complications (1 infection and 2 local recurrences) that may be attributed to the procedure occurred in 3 of the 19 patients. CONCLUSION: Despite an overall complication rate of 74% the Tikhoff-Linberg procedure proved to be a valuable surgical procedure for extended tumors of the shoulder girdle for functional and oncological outcome and is superior to forequarter amputation.     

The role of limb salvage surgery and custom mega prosthesis in multiple myeloma

Nine patients with multiple myeloma underwent limb salvage surgery and custom megaprosthesis replacement for tumours involving long bones. The lower limb was commonly involved with an average age of 47.7 years at presentation. All patients had pathological fractures. Resection and reconstruction was done using custom megaprostheses. A proximal femoral prosthesis was used for proximal femoral tumours and an intercalary prosthesis for tumours involving the femoral shaft. One patient each had total femoral prosthesis and total knee prosthesis. With an average follow-up of 88.2 months, three patients died of their disease. One patient with total knee prosthesis had delayed deep infection requiring removal of the prosthesis and another patient with an intercalary prosthesis had a periprosthetic fracture and declined revision surgery. Radiological evidence of loosening was seen in one patient. The functional outcome was excellent in 3 and good in 3 patients. The 5-year Kaplan-Meier survival rate of the patients was 66.7%.     

Transurethral endoscopic treatment of upper urinary tract tumors using a holmium:YAG laser

BACKGROUND AND OBJECTIVES: The feasibility of treating upper urinary tract tumors with a holmium:YAG (Ho:YAG) laser in transurethral endoscopy was examined. STUDY DESIGN/MATERIALS AND METHODS: Thirty-three treatments were performed on 30 patients with renal pelvic and ureteral carcinomas. After vaporization and coagulation eliminated the tumors, the surrounding mucosa was fully coagulated. Postoperative follow-up consisted of urinary cytology once a month, cystoscopy every 3 months, excretory pyelography every 6 months, and uretero-pyeloscopy every 6-12 months. RESULTS: The recurrence rate after the first treatment was 86% in the imperative indication group. The tumor-free rate (median follow-up, 37 months) in the imperative indication group was 57%. In the elective indication group, those values were 20 and 95% (median follow-up, 33 months), respectively. CONCLUSIONS: Transurethral endoscopic treatment of upper urinary tract tumors using Ho:YAG laser can be a useful method on limited cases identified into specific treatments groups combined with a strict follow-up.     

Long-term follow-up of endoscopically treated upper urinary tract transitional cell carcinoma

Objectives

This report focuses on the long-term follow-up of patients with endoscopically treated upper tract transitional cell carcinoma (TCC) to determine the effectiveness of endoscopic therapy.

Methods

From May 1983 to April 1994, 44 patients with TCC of the upper urinary tract underwent conservative endourologic treatment with either electrocautery fulguration or neodymium:yttrium-aluminumgarnet laser at our institution. The mean follow-up period was 5 years (range, 3 months to 11 years).

Results

Renal pelvic tumor sizes ranged from 0.4 to 4.0 cm (mean, 1.5) and ureteral tumors from 0.2 to 1.0 cm (mean, 0.5). The majority of tumors were of pathologic grade 3 or less, and all were Stage T2 or less. Seventeen of 44 patients (38.6%) had local tumor recurrence (mean time to recurrence, 12.8 months; range 1.5 to 64). Mean recurrence time was 7.3 months for renal pelvic tumors and 17.8 months for ureteral tumors. Nineteen of 44 patients (43.2%) developed bladder tumors. The overall 5-year disease-free rate was 57%. No recurrent tumor was shown to have increased in grade, and one recurrent tumor was proved to have progressed in stage. Six patients (14%) ultimately required a nephroureterectomy for recurrence. There were no major complications as a result of endoscopic therapy. Six patients (14%) died of the effects of metastatic TCC, 5 of whom had known muscle invasive bladder TCC.

Conclusions

Endourologic techniques and the conservative treatment of upper urinary tract TCC is an evolving field and can be safely and effectively used as a first-line treatment for upper tract TCC in selected patients.     

Pelvic reconstruction using saddle prosthesis following limb salvage operation for periacetabular tumour

PURPOSE: To assess the clinical results of pelvic reconstruction using a saddle prosthesis following limb salvage operation for periacetabular tumour. METHODS: 12 patients with sarcoma and 4 with metastasis involving the pelvis were treated using the saddle prosthesis between 1995 and 2003 inclusive. Wide pelvic resection was performed for all patients with sarcoma and one with a metastatic lesion; intralesional excision of the acetabulum was undertaken for the remaining 3 patients with metastatic lesions. Oncologic prognosis, operation time, postoperative function, and complications were assessed retrospectively. RESULTS: Of the 12 patients with sarcomas, 5 were alive without evidence of recurrence after a mean follow-up of 37 months, one was alive with disease, 3 died of the disease, and 3 of other medical conditions. Respective mean postoperative functional scores according to the Musculoskeletal Tumor Society-International Symposium on Limb Salvage system and the Toronto Extremity Salvage Score were 53 and 64% in patients undergoing wide acetabular resection, and 30 and 42% in patients undergoing intralesional excision of the acetabulum. In patients undergoing wide acetabular resection and intralesional excision of the acetabulum, the mean operation times were 391 and 162 minutes respectively, whereas the mean times to ambulation were 7 and 4 days respectively. Major complications included infection and dislocation. CONCLUSION: Saddle prosthesis arthroplasty is a useful option for pelvic reconstruction following resection of acetabular malignancies. It is associated with a short operation time, rapid recovery, and moderately good postoperative function, but a relatively high risk of complications.     

Reoperation results after segmental prosthetic replacement of bone and joint for limb salvage.

Thirty-eight patients who had undergone reoperations because of complications or implant failure subsequent to a prosthetic replacement for limb salvage procedure for the treatment of musculoskeletal neoplasm were followed until death or a minimum of 2 years, then reviewed. The mean follow-up time before reoperation was 35 months, and the mean follow-up time after reoperation was 51 months. The major indication for reoperation was aseptic loosening (34%). The reoperative procedures included 19 major revisions of the prosthesis and 19 other reconstructions. There were 7 complications, including 1 local tumor recurrence. Twelve patients died of metastatic disease at a mean of 16 months after reoperation. The probability for patient survival was 74% beyond 3 years and 67% after 5 years. The surgical staging, site of tumor involvement, and type of reoperation all correlated with long-term patient survival. Overall, 72% of the patients achieved excellent or good functional results: a rate that was slightly inferior to that of the initial arthroplasty. Despite this, 84% of the implants demonstrated either excellent or good performance at 5 years. Therefore, reoperation because of a failed initial prosthesis or for other reasons after a limb salvage procedure using custom-designed or modular-segmental bone and joint implants seems feasible with no significant effect on subsequent functional performance or on patient survival.     

骨肿瘤初次保肢手术后生物性重建失败的肿瘤假体翻修术

目的评估骨肿瘤初次保肢手术后生物性重建失败的肿瘤假体翻修的疗效。方法2004至2006年，13例骨肉瘤和3例骨巨细胞瘤患者在香港威尔斯亲王医院接受手术治疗。15例患者应用同种异体骨重建，另1例患者应用带血管腓骨移植重建骨缺损。应用肿瘤型假体进行翻修手术的重建。翻修术后患者膝关节活动范围良好时，订制的可延长假体接受延长手术。结果患者平均年龄23．2岁（13～43岁），平均随诊26．4个月（6～47个月）。翻修手术的原因包括：7例患者出现同种异体骨骨折或软骨下骨塌陷，5例患者骨不愈合，3例患者异体骨感染，1例患者膝关节僵硬。翻修手术的假体包括10例患者应用订制型假体，其他患者应用组合式假体。翻修手术的部位包括9例股骨远端假体，6例胫骨近端假体和1例股骨中段假体。订制假体中6例是可延长假体，假体的延长方式中5例是微创延长、1例无创延长。翻修手术后，膝关节活动改善，平均从18．1&#176;（0&#176;-90&#176;）至91．9&#176;（50&#176;-120&#176;）。下肢缩短不等长畸形从平均5cm（2-11．5cm）纠正至平均1．5cm（0-4cm）。翻修术后患肢功能MSTS评分从34．6％改善到89．2％。翻修术后2例患者出现部分皮肤坏死，1例患者出现腓总神经麻痹，以后部分恢复，1例患者出现胫骨裂纹骨折；没有感染和植入物失败。结论保肢手术后生物学重建失败所引起下肢缩短和僵硬，应用人工假体翻修是可行的，早期效果令人鼓舞。膝关节僵硬患者可获得良好的关节活动度。严重的下肢缩短畸形通过可伸长假体逐渐获得纠正。     

Penile prosthesis implantation for the treatment for male erectile dysfunction: clinical outcomes and lessons learnt after 955 procedures

Purpose

To evaluate the clinical outcomes of penile prosthesis implantation for the treatment for erectile dysfunction (ED) over 3 decades in a centre of excellence.

Methods

A total of 955 penile prostheses were implanted between June 1981 and June 2010. The mean age of the men was 53.2 (28–80) years, and the mean follow-up was 76 (12–355) months. A total of 771 men had primary implants. The most common implant was Ultrex cylinder (54 %), and the main cause of ED was organic (32 %).

Results

Primary implants showed higher rate of intra-operative complications than revision surgery (3.5 vs. 0.1 %) (p < 0.05). Prosthesis infection occurred in 0.8 % and equal incidence between diabetic and pelvic trauma patients. The average time to prosthetic revision was 102 (30–210) months. Kaplan–Meier estimates of overall penile prosthesis survival at 5 and 10 years were around 90.8 and 85.0 %. The most common mechanical failures were fluid loss (75 %). The majority of men were satisfied with the surgical outcomes, and 90 % of men would undergo penile prosthesis implant again.

Conclusions

Penile prosthesis surgery is a safe and durable treatment option for male ED. Strict adherence to antimicrobial prophylaxis and surgical practice is paramount to ensure low complication rates and high patient satisfaction rate.     

髋臼周围恶性肿瘤切除后股骨头旷置术的临床应用

目的 探讨髋臼周围恶性肿瘤切除后股骨头旷置术的临床应用.方法 1997年5月至2005年6月共有25例切除后采用股骨头旷置术的髋臼周围恶性肿瘤患者得到随访,其中男性15例,女性10例;年龄16～75岁,平均42岁;骨肉瘤4例,软骨肉瘤12例,尤文肉瘤1例,原始神经外胚层瘤1例,骨髓瘤1例,恶性纤维组织细胞瘤1例,滑膜肉瘤2例,转移性肿瘤3例.根据Enneking骨盆肿瘤分区:肿瘤累及Ⅰ、Ⅱ区12例;Ⅰ、Ⅱ、Ⅲ区5例;Ⅱ、Ⅲ区4例;Ⅱ区2例;Ⅰ、Ⅱ、Ⅳ区2例.共有7例行新辅助化疗,5例行单纯术后辅助化疗,4例行术后放疗.髋臼周围切除后,采用股骨头旷置术,术后皮牵引6～8周,牵引质量2～3 kg.以后扶拐逐渐步行活动.结果 25例股骨头旷置术中6例出现手术后并发症(24.0%).随访时间3～10年,11例由于肺转移或远处转移并发肺转移死亡;2例带瘤生存;12例无瘤生存.术后5年及10年生存率分别为60%和54%.股骨头旷置术后肢体短缩在2.5～7.5 cm,平均5 cm.本组病例术后功能评价根据Enneking1993MSTS评分系统进行,平均术后功能评分是17分(12～19分).术后3个月后,患者基本能够正常坐,扶单拐跛行,能自主上下楼梯,去拐后也能跛行行走.结论 累及髋臼周围的恶性肿瘤,切除后股骨头旷置术是一种可选择的重建方式,能取得相对满意的临床效果.髋臼周围高度恶性肿瘤、软组织重建条件不佳、具有感染高危倾向者、经济条件不佳的患者,是股骨头旷置术的适应证.

Abstract：

Objective To discuss the resection pseudoarthrosis for pelvic malignant tumors around acetabular. Methods From May 1997 to June 2005, 25 patients with malignant tumors around acetabular were treated surgically with resection pseudoarthrosis. The series comprised 15 males and 10 females with an average age of 42 years old (range from 16 to 75 years old ) . There were 4 osteosareomas, 12chondrosarcomas, 1 Ewing's sarcoma, 1 neuroectodermal tumor, 1 myeloma, 1 malignant fibrohistiocytoma,2 synovial sarcomas, and 3 metastases. Pseudoarthrosis was performed after resection of pelvic malignant tumors around acetabular. The affected side was protected postoperatively by skin traction with 2-3 kg weight for 6 to 8 weeks. After then, the patients walked gradually with a cane. Results Among 25 patients, 6 had complications(24% ). At a follow-up ranging from 3 to 10 years, 11 patients died of lung metastases, 2relapsed, 12 remained alive free of disease. There was an average crispation of 5 cm( range from 2. 5 to 7.5cm). The patients were functionally evaluated according to Enneking's MSTS criteria in 1993. The average MSTS functional score was 17 points ( 12 to 19 points). After 3 months postoperative, the patients could sit normally, walk with a cane, and even walk limpingly without cane. Conclusions Resection pseudoarthrosis for pelvic malignant tumors around acetabular results in good clinical results at the time of mid-term and long-term follow-up. And pseudoarthrosis is advisable especially for patients with malignant highly tumors around acetabular, poor soft tissue reconstruction condition, high risk for infection, poor economy.     

Non-invasive expandable prosthesis in musculoskeletal oncology paediatric patients for the distal and proximal femur. First results

Purpose

The non-invasive expandable prosthesis for skeletally immature patients is used after limb salvage surgery following tumor resection. The aim of the study was to assess the effectiveness of this treatment.

Methods

Seven paediatric patients with femoral tumors had resection and limb salvage with an uncemented non-invasive growing prosthesis. Mean age at the time of surgery was 9.8 (range 8–12) years. There were six distal femur osteosarcomas and one proximal femur Ewing sarcoma. Six total knee prosthesis were implanted at the time of primary tumor resection and one bipolar hip prosthesis was a revision from a failed osteoarticular hip allograft. Functional outcomes and emotional acceptance were assessed using the MSTS score.

Results

The mean follow-up was 65.3 months (range 29–91) months. Two patients died of pulmonary metastasis and there was no local recurrence. The mean femoral resection was 18 cm (range 17–19) on the knee, and 24 cm on the hip. Mean total expansion was 36.4 mm (range 12.3–63.5). The mean MSTS score after rehabilitation was 26.3 (range 21–29). There was one lengthening device failure, one late infection and one patient who required iliofemoral bypass grafting surgery for a pelvic metastasis. No local recurrence occurred.

Conclusions

The non-invasive expandable prosthesis reduces the final limb-length discrepancy in growing patients with an acceptable function and appears to have an advantage as compared to invasive expandable prostheses which require multiple surgical procedures, but the complications rate is still high.