髋臼周围恶性骨肿瘤的切除与重建

背景：累及髋臼的恶性肿瘤由于位置较深,毗邻重要的血管神经和内脏器官,因而切除困难。切除后如何恢复骨盆连续性和髋臼功能的方法仍需完善。目的：探讨累及髋关节恶性肿瘤切除和重建的方法和效果。方法：回顾性研究2004年1月至2010年12月22例累及髋臼的骨盆恶性肿瘤的切除和重建,分析患者的生存、肿瘤复发和转移、术后并发症,并利用MSTS评分系统对患者的功能进行评估。结果：全部获得随访,随访时间为7.1～84.3个月,平均37.0个月。15例无病生存,5例死于肿瘤复发和转移,2例带瘤生存。7例患者出现局部复发,局部复发率为31.82%,术后复发间期为3.0～41.2个月,平均17.1个月。4例患者发生肿瘤肺转移,术后转移间期为5.8～38.1个月,平均16.6个月。术后6个月的MSTS功能评分为32.5%～83.7%,平均68.6%。结论：对累及髋臼的恶性骨肿瘤进行广泛性切除并根据骨缺损的程度选择不同类型的组配式假体重建可以获得较好的疗效和功能。

Resection and reconstruction for malignant bone tumors involving the acetabulum

Background：The location of the malignant tumors involving the acetabulum are comparatively deep,and they are usually very closed to some vital blood vessels,nerves and visceral organs,thus are very difficult to be resected.Methods to restore the continuity of pelvis and the function of acetabulum still need further improving.Objective：To investigate the methods and effects of the resection and reconstruction for malignant tumors involving the acetabulum.Methods：Retrospectively study 22 cases of resection and reconstruction for malignant bone tumors involving the acetabulum during January 2004 to December 2010.Analyze the survival of the patients,the recurrence and metastasis of the tumor,and the complications after the surgery,then evaluate the function of the patients via MSTS score system.Results：All the 22 patients were followed up for a mean period of 37.0 months（7.1 to 84.3 months）.15 patients gained a disease-free survival,5 patients died of recurrence and metastasis of tumor,and 2 patients survived with the tumor.7 patients underwent local recurrence,which leads to a local recurrence rate of 31.82%.The mean interval from the operation to the local recurrence was 17.1 months（3 to 41.2 months）.4 patients had lung metastasis with an interval of 5.8 to 38.1 months after the operation,the mean interval was 16.6 months.The mean MSTS score detected six months after the operation was 68.6%（32.5%-83.7%）.Conclusions：Treat the malignant bone tumor involving the acetabulum with extensive resection and reconstruct the acetabulum with customized modular prostheses according to the degree of bone defects can achieve satisfactory curative effects and good function of the acetabulum.