髋臼及其周围肿瘤的分区与重建方法

目的 回顾性分析髋臼及其周围恶性肿瘤行整块切除、不同方法髋臼重建的疗效.方法 72例髋臼及其周围恶性肿瘤患者接受了肿瘤整块切除、髋臼重建手术,男42例,女30例;年龄16～78岁,平均41岁.软骨肉瘤39例、骨肉瘤10例、骨巨细胞瘤9例、Ewing肉瘤5例、恶性纤维组织细胞瘤3例、恶性神经鞘瘤2例、血管外皮瘤l例、单发转移癌3例.肿瘤累及Ⅱ区、Ⅰ+Ⅱ区、Ⅱ+Ⅲ区、Ⅰ～Ⅲ区、Ⅰ～Ⅳ区和Ⅱ+Ⅲ+Ⅴ区者分别为4、16、29、7、10和6例.髋臼重建包括组配式人工半骨盆50例、马鞍式关节置换7例、骨盆灭活再植8例、股骨近端与盆骨融合7例.结果 61例获得随访,平均随访3.5年(1～8年).11例局部复发,8例深部感染,6例脱位.45例行组配式人工半骨盆置换术患者ISOLS评分平均22分.优7例、良24例、可9例、差5例.其中优良病例均为累及Ⅱ区和Ⅱ+Ⅲ区者,评分差的病例均为累及Ⅳ区者.5例行马鞍式关节置换、5例骨盆灭活再植和6例股骨近端与盆骨融合术患者,ISOLS评分平均为10、17和14分.结论 髋臼周围肿瘤切除后重建方法以组配式人工半骨盆置换术后功能最好,骨盆灭活再植次之,马鞍式关节置换术后功能最差.组配式人工半骨盆置换对单纯Ⅱ区肿瘤切除重建功能最好,其次为Ⅱ+Ⅲ区、Ⅰ+Ⅱ区、Ⅰ～Ⅲ区、Ⅱ+Ⅲ+Ⅴ区,术后功能最差为Ⅰ～Ⅳ区.

Types and evaluation of reconstruction approach for malignant pelvic tumors around acetabulum

Objective To evaluate the functional outcome of malignant periacetabular tumors treated by en bloc resection and reconstructed with different limb-salvage procedures. Methods Seventy-two pa-tients with tumors around acetabular were treated surgically in People's Hospital of Peking University be-tween July 2000 and July 2007, including 42 males and 30 females with an average age of 41 years (range,16-78). 39 patients were diagnosed with chondrosarcoma, and 10 with osteosarcoma, 9 with giant cell tumorand 5 with Ewing sarcoma, etc. Type Ⅱ, Ⅰ + Ⅱ, Ⅱ + Ⅲ, Ⅰ - Ⅲ, Ⅰ -Ⅳ, Ⅱ + Ⅲ +Ⅴ pelvic resection were 4,16, 29, 7, 10 and 6, respectively. Of 72 patients, 50 were reconstructed with modular hemipelvic prosthesis,7 with saddle prosthesis, 8 with cauterized tumor bone implantation and 7 with proximal femur and pelvicbone fusion. Results Sixty-one patients were successfully followed up, and the average time was 3.5 years.Eleven patients (18%) had local relapse, 8 deep infection and 6 dislocation. The average ISOLS evaluationscore was 22 for 45 patients with modular pelvic prosthetic reconstruction, including excellent in 7, good in24, fair in 9 and poor in 5, respectively. Type Ⅱ and Ⅱ +Ⅲ pelvic resection with reconstruction was ratedexcellent or good, in contrasted to type Ⅳ was poor. The average ISOLS evaluation score for 5 saddle pros-thetic reconstruction, 5 recycled tumor bone reimplantation and 6 proximal femur and pelvic bone fusion was11, 17 and 14, respectively. Conclusion Among the 4 different reconstruction methods, the patients withmodular pelvic prosthetic reconstruction had best function results, and the saddle prosthetic reconstructionhad the worst. In terms of different types of pelvic resection with modular pelvic prosthetic reconstruction,type Ⅱ had the best functional result, followed by type Ⅱ + Ⅲ, Ⅰ + Ⅱ, Ⅰ - Ⅲ, Ⅱ + Ⅲ + Ⅴ, and type Ⅰ - Ⅳhad the worst.