3D全仿真解剖型半骨盆假体治疗骨盆软骨肉瘤临床疗效的初步分析

Clinical efficacy of 3D anatomical hemipelvic prosthesis in the treatment of pelvic chondrosarcoma

目的探讨应用3D全仿真解剖型半骨盆肿瘤假体重建骨盆肿瘤切除术后骨缺损的可行性、安全性和有效性。方法对2016年3月至2018年6月收治的3例骨盆软骨肉瘤患者(年龄49~61岁),根据Enneking分类,肿瘤累及Ⅰ+Ⅱ+Ⅲ区,行肿瘤切除后应用3D全仿真解剖型骨盆假体进行半骨盆重建。采用耻骨结节-髂后上棘和外侧辅助入路,记录术中出血量、输血量、手术时间以及肿瘤复发、转移等并发症情况。采用视觉模拟量表(VAS)评分和Harris评分标准对疼痛和髋关节功能进行评估。结果 3例患者术后均获得随访,随访时间18~41个月,中位随访时间27.6个月。术中平均失血量(2266.67±1078.57)ml,输血量(2660.00±1278.59)ml。Harris疼痛评分由术前(28.00±4.35)分提高为术后(57.00±6.24)分;VAS评分为由术前(8.33±0.57)分降低为术后(3.00±2.00)分。无髋关节脱位、假体松动、伤口愈合延迟、假体周围感染、局部复发等并发症发生。结论应用3D全仿真解剖型半骨盆假体重建骨盆软骨肉瘤切除术后骨缺损是一种安全有效的方法。

Objective To investigate the feasibility,safety,and effectiveness of 3 D anatomical hemipelvic prosthesis in reconstructing bone defects after tumor resection. Methods Three patients aged 49 to 61 with pelvic tumor resection underwent reconstruction using 3 D-printing anatomical-conforming hemipelvic prosthesis between March 2016 and June 2018. According to Enneking classification,the pelvic chondrosarcoma involved theⅠ+Ⅱ+Ⅲareas. The intraoperative blood loss and blood transfusion volume,duration of surgery,tumor recurrence and metastasis were recorded through the pubic tubercle-posterior superior iliac spine combined with the lateral auxiliary approach. Using VAS and Harris scores,the pain and hip joint function were measured preoperatively and postoperatively. Results All the patients were followed up for 18 to 41 months(median 27.6 months). The average blood loss was(2266.67±1078.57)ml and blood transfusion was(2660.00±1278.59)ml. During the last follow-up,the Harris hip score increased from(28.00±4.35)points preoperatively to(57.00±6.24)points,while the VAS pain score decreased from(8.33±0.57)points preoperatively to(3.00±2.00)points. There was no hip dislocation,prosthesis loosening,delayed wound healing,periprosthetic infection,local recurrence or other complications. Conclusion It is a highly safe and effective approach to reconstruct the bone defect after resection of pelvic chondrosarcoma using the 3 D anatomical hemipelvic prosthesis.