髋臼周围肿瘤的切除与重建

Reconstruction after resection of periacetabular tumors

目的探讨髋臼周围肿瘤切除保肢的适应证及手术方法，并对自制人工骨盆假体的设计及应用效果进行评价。方法回顾分析2003年至2010年我们参与工作的11例骨盆髋臼周围肿瘤切除后并使用自制人工骨盆假体修复重建的临床资料。其中男8例，女3例，年龄16—65岁，平均43．1岁。软骨肉瘤4例，骨肉瘤2例，骨巨细胞瘤1例，恶性纤维组织细胞瘤1例，转移瘤3例。本组病例中对化疗敏感的原发恶性肿瘤均经术前、术后的系统化疗。对于转移性肿瘤术后进行了放疗和化疗。根据肿瘤的性质、破坏部位、肿瘤大小，有3种不同的外科术式。结果11例患者均按术前方案切除肿瘤并安装自制人工骨盆假体重建髋关节。除1例软骨肉瘤患者术后失访外，其余10例均获随访，最长随访时间118个月，最短13个月，中位时间58．5个月。1例肝癌骨转移患者术后存活13个月，1例骨肉瘤患者术后42个月出现肺转移死亡，2例转移性肿瘤患者目前带瘤生存，其余6例术后未发现复发、转移，能独立行走，均有不同程度的跛行，可站、坐、蹲。人工骨盆假体无松动，部分患者假体骨性愈合明显，髋关节稳定，活动度较好。结论彻底切除肿瘤是治疗骨盆原发肿瘤，防止复发，达到长期治愈的关键。对于髋臼周围破坏广泛的转移性肿瘤刮除病灶后使用人工骨盆假体和填充骨水泥进行重建，可获得较好治疗效果。

Objective To investigate the indications of limb salvage after resection ot perlacetabular tumors and the operative methods, and to evaluate the design and application effects of self-made artificial pelvic prostheses. Methods The clinical data of 11 patients with periacetabular tumors of the pelvis who were treated with tumor resection and reconstruction using self-made artificial pelvic prostheses from 2003 to 2010 were retrospectively analyzed. Among them, there were 8 males and 3 females, whose average age was 43.1 years old （ range, 16-65 years ）. There were 4 cases of chondrosarcomas, 2 cases of osteosarcomas, 1 case of giant cell tumors of bone, 1 case of malignant fibrous histiocytomas and 3 cases of metastatic tumors. The preoperative and postoperative systematic chemotherapy was applied to the patients with primary malignant tumors who are sensitive to chemotherapy. As to the patients with metastatic tumors, postoperative radiotherapy and chemotherapy were performed. There were 3 different kinds of operative methods, depending on the characteristics and sizes of the tumors and the damaged positions. Results According to the preoperative plan, all 11 patients had tumors resected, and self-made artificial pelvic prostheses were used to reconstruct the hip joints. Except for 1 patient with chondrosarcomas who failed to be followed up postoperatively, all the left 10 patients were followed up for a median of 58.5 months （ range; 13-118 months ）. 1 patient with liver cancer lived for 13 months after the operation. 1 patient with osteosarcomas died of lung metastases at the 42nd month after the operation. 2 patients with metastatic tumors still lived with cancer now. The left patients survived after the operation, and no recurrence or metastasis was found. They could walk independently, stand, sit and squat but crippled in different degrees, and their artificial pelvic prostheses maintained firm. Partial patients＇ prostheses showed good bony union, and they could move flexibly with steady hip joints. Conclusions A complete resection of pelvic tumors is the key procedure for treating primary tumors of the pelvis, avoiding recurrence and achieving long-term cure effects. The application effects of self-made artificial pelvic prostheses are satisfactory in all the cases. As to the metastatic periacetabular tumors which are extensively destructive to the pelvis, artificial pelvic prostheses and bone cements can be applied in the reconstruction after curettage, with good curative effects.