新型复合重建技术重建髋臼周围肿瘤切除后骨缺损

Reconstruction with a new type of combined reconstruction following excision of periacetabular tumors

目的评价新型复合重建技术对髋臼周围肿瘤切除后骨缺损的重建效果。方法2001年3月至2007年3月，对23例髋臼周围肿瘤患者行切除复合重建，其中男性16例，女性7例，平均年龄43岁（16—78岁）。肿瘤类型：原发性恶性骨与软组织肿瘤17例，其中软骨肉瘤7例、成骨肉瘤4例、尤文肉瘤2例、恶性纤维组织细胞瘤2例、恶性神经鞘瘤1例、滑膜肉瘤1例；骨巨细胞瘤2例；侵袭性骨母细胞瘤1例；转移瘤3例，其中甲状腺癌1例、乳腺癌1例、卵巢癌1例。术后对肿瘤控制和功能结果进行评定。结果原发性恶性骨盆肿瘤中IA期1例，ⅠB期5例，ⅡA期3例，ⅡB期8例，3例良性骨肿瘤均为Ⅲ期，原发瘤患者平均随访时间36．8个月（9—73个月）；3例转移瘤患者生存期9．6—36．6个月。肿瘤局部复发4例，肺转移5例，死亡5例，术后无深部感染和皮肤坏死。深静脉血栓2例；坐骨神经不全损伤1例，股骨头假体脱位2例，螺钉松动3例，肢体短缩3例，其中植入物相关并发症发生率为21．7％，术后6个月MSTS功能评分平均为68％；随访5年以上的6例患者MSTS功能评分平均为62％。结论新型复合重建技术可有效重建髋臼周围肿瘤切除后骨缺损同时可以较好恢复髋关节功能，术后并发症少。

Objective To evaluate the reconstructive effect of a new pattern of combined reconstruction after periacetabular tumor resections. Methods Between March 2001 and March 2007, tumor resections and new pattern of combined reconstructions which consisted of screw-rod system, acetabular reinforcement shell, antibiotic cement and total hip arthroplasty techniques were performed in 23 patients with periacetabular tumors. There were 7 females and 16 males. The mean age was 43 years （ range, 16-78 years）. Seventeen patients had primary malignant tumors including 7 chondrosarcomas, 4 osteosarcomas, 2 Ewing sarcomas, 2 malignant fibrohistiocytomas, 1 malignant Schwannomas, and 1 synoviosarcomas. Other primary tumors were 2 giant cell tumors and 1 aggressive osteoblastoma. Three metastatic bone tumors were also included in this study, and the original sites were thyroid, breast, and ovary. Results According to Enneking＇s staging system, there were 1 case in Ⅰ A, 5 cases in Ⅰ B, 3 cases in ⅡA, and 8 cases in Ⅱ B. Three primary benign bone tumors belonged to stage Ⅲ. The average follow-up was 36. 8 months （ range, 9- 73 months） in the patients with primary tumors. The survival time in 3 patients with metastatic disease were between 9. 6 months and 36. 6 months. There were 4 patients who had local recurrence, 5 patients had pulmonary metastases, and 5 patients died of disease. No wound complication was encountered. The postoperative complications included 3 cases of screw loosening, 2 cases of prosthetic dislocation, 3 cases of leg length discrepancy, 2 cases of deep vein thrombosis, 1 case of partial neuropraxia of sciatic nerve. The complication rate related to implants was 21.7%. The average MSTS functional score was 68% for all patients at 6 months postoperatively, and 62% for 6 patients with follow-up time more than 5 years. Conclusions This new combined reconstruction is an effective way to rebuild pelvic ring and maintain hip function with low complication rate after periacetabular tumor resections.