带翼型髋臼加强杯在重建髋臼肿瘤切除后骨缺损中的应用

UTILIZATION OF REINFORCED ACETABULAR CAGES WITH CAUDAL FLANGE IN RECONSTRUCTING PELVIC DEFECT AFTER ACETABULAR TUMOR RESECTION

目的探讨带翼型髋臼加强杯在重建髋臼肿瘤切除后骨缺损中的应用。方法 2003年6月-2009年12月,对25例髋臼肿瘤切除后HarringtonⅢ型骨缺损患者行带翼型髋臼加强杯联合人工全髋关节置换重建术。男13例,女12例;年龄13～73岁,平均51.2岁。患者主要临床症状为患侧髋部及臀部疼痛;病程1～96个月,中位病程6个月。转移瘤18例,多发性骨髓瘤3例,非何杰金淋巴瘤、Ⅰ级软骨肉瘤、骨巨细胞瘤、软骨母细胞瘤各1例。1例软骨母细胞瘤患者联合应用RIBBED人工全髋关节(LINK公司,德国),6例应用国产春利正达骨水泥型人工全髋关节,其余患者均应用SPⅡ人工全髋关节(LINK公司,德国)。结果围手术期无死亡患者,发生深部感染1例、髋关节假体脱位2例。转移瘤患者中,8例死于肿瘤进展,平均生存11个月;10例患者生存,平均随访时间15个月。1例多发性骨髓瘤患者术后21个月死于肺部感染;其余多发性骨髓瘤及非何杰金淋巴瘤患者均生存,平均随访时间17个月。软骨母细胞瘤与软骨肉瘤患者分别随访58个月及12个月,无肿瘤局部复发。骨巨细胞瘤患者术后19个月肿瘤复发。3例患者因肿瘤复发导致髋臼内植物松动,其余患者均未出现内植物失败。23例患者术后6个月关节功能行美国骨与软组织肿瘤协会(MSTS 93)功能评分系统评分,为57%～93%,平均81%。结论采用带翼型髋臼加强杯重建HarringtonⅢ型髋臼骨缺损,联合人工全髋关节置换,术后并发症发生率低,重建关节功能较好。

Objective To evaluate the surgical procedure of reinforced acetabular cage with caudal flange in reconstruction of pelvic defect after acetabular tumor resection.Methods Between June 2003 and December 2009,25 patients with Harrington class III pelvic defect underwent reconstruction with a reinforced acetabular cage with caudal flange and total hip arthroplasty（THA）.There were 13 males and 12 females with an average age of 51.2 years（range,13-73 years）.The main clinical manifestations included hip pain and buttock pain,with a median disease duration of 6 months（range,1-96 months）.Pathological findings showed 18 cases of metastasis,3 cases of multiple myeloma,1 case of non-Hodgkin’s lymphoma,1 case of grade I chondrosarcoma,1 case of giant cell tumor,and 1 case of chondroblastoma.For the patient with chondroblastoma,THA with LINK RIBBED system was used.An artificial total hip system made in China was used in 6 patients and LINK SP II system was used in the other 18 patients.Results No patients died perioperatively.Deep infection and hip dislocations occurred in 1 and 2 patients,respectively.At last follow-up,8 of 18 patients with metastasis died of cancer and the average survival time was 11 months.The other 10 who were alive were followed up 15 months on average.One patient with multiple myeloma died of pulmonary infection at 21 months after operation and the other 2 with multiple myeloma and 1 with lymphoma were alive with an average follow-up of 17 months.The patient with grade I chondrosarcoma and patient with chondroblastoma were followed up 58 and 12 months,respectively,without recurrence.Recurrence occurred in the patient with giant cell tumor at 19 months after operation.Loosening of implant occurred in 3 patients because of local tumor recurrence.For the 23 patients at 6 months after operation,the mean Musculoskeletal Tumor Society（MSTS） 93 score was 81%（range,57%-93%）.Conclusion Reinforced acetabular cage with caudal flange could be used together with THA for reconstruction of Harrington class III pelvic defects after acetabular tumor resection,and low incidence of postoperative complication and good functional outcome could be expected.