骨盆髋臼周围恶性肿瘤切除后人工骨盆假体重建手术探讨——附12例报告

背景与目的:骨盆髋臼周围的恶性肿瘤,由于肿瘤部位深,切除范围又是身体负重力线必经之路,故肿瘤切除及肿瘤切除后骨盆髋关节的修复重建,是骨肿瘤手术治疗中一项非常复杂的外科技术.本文总结骨盆髋臼周嗣恶性肿瘤的切除及肿瘤切除后骨盆髋关节假体修复重建的方法和临床经验.方法:回顾中山大学附属第一医院1995年至2006年对12例骨盆髋臼周围恶性肿瘤切除后进行骨盆及髋关节假体修复重建的临床资料,就术前准备、手术方案制定、肿瘤假体设计、手术操作、髋关节修复重建、术后肢体功能康复训练等进行分析,探讨该类肿瘤的临床手术治疗特点.结果:12例均能按照原定手术方案切除肿瘤和修复重建髋关节,术后随访时间8～86个月,中位时间46个月,4例复发,其中2例骨肉瘤患者分别在术后15个月和22个月死于双肺广泛转移;1例软骨肉瘤患者术后26个月局部复发,38个月死亡;1例骨巨细胞瘤患者术后13个月局部复发,再行局部病灶清除术,至末次随访日未见再复发.其余病例至末次随访仍生存,未见肿瘤复发或转移.按Kaplan-Meier法计算1年生存率为75.0%,3年、5年生存率均为33.3%,7年生存率为25.0%.肢体功能评分参照人工全髋关节置换术后Rarris评分标准,60～69分3例,70～79分5例,80～90分4例.结论:骨盆肿瘤切除及髋关节假体修复重建具有手术难度大、风险高的特点,对于恶性程度相对较低的骨肿瘤,该手术治疗是较理想的方法之一.

Reconstruction of the hemipelvis with saddle prosthesis after excision of malignant tumors around the pelvis and acetabulum: a report of 12 cases

BACKGROUND & OBJECTIVE: Malignant tumors around the pelvis and acetabulum locate deeply with complex anatomic structure, meanwhile, the resection area involves the weight-loading alignment. Therefore, tumor resection plus acetabular joint reconstruction is a complicated operation. This study was to summarize our experience of tumor resection plus prosthesis reconstruction of the acetabular joint for this disease. METHODS: Clinical data of 12 patients with malignant tumors around the pelvis and acetabulum, treated with tumor resection plus prosthesis reconstruction of the acetabular joint from 1995 to 2006, were reviewed. The characteristics of the operating for this disease were analyzed in terms of preoperative preparation, operating strategy, prosthesis design, operating procedure, acetabular reconstruction, and postoperative rehabilitation. RESULTS: The patients were followed for 8-86 months, with a median of 46 months. Of the 4 patients with tumor relapse, 2 osteosarcoma patients died of lung metastasis at 15 months and 22 months after operation; 1 chondrosarcoma patient relapsed locally at 26 months after operation and died at 38 months after operation; 1 giant cell tumor patient relapsed locally at 13 months after operation and was treated by clearance of focal lesion, and survived tumor-freely till the end of follow-up. The other 9 patients still survived tumor-freely till the end of follow-up. The 1-year survival rate was 75.0%; the 3-and 5-year survival rates were 33.3%; the 7-year survival rate was 25.0%. According to Harris scoring criteria after total hip replacement, 3 patients scored 60-69, 5 scored 70-79, and 4 scored 80-90 in limb function. CONCLUSIONS: Pelvic tumor resection and prosthesis reconstruction of the acetabular joint has the characteristics of difficulty and high-risk. For bone tumors with relatively low malignancy, this surgical treatment is an ideal option.