肿瘤性部分髋臼骨缺损的重建方法

The reconstruction of tumorous partly defect in acetabulum

目的探讨累及部分髋臼原发骨恶性肿瘤的手术切除重建方法和临床随访。方法收集2009年1月至2015年1月共20例累及部分髋臼的原发骨恶性肿瘤患者的资料，男13例，女7例；年龄23~69岁，平均48岁。根据髋臼肿瘤的分型切除肿瘤并重建髋臼。A型，切除耻骨支及部分髋臼，采用骨盆重建钢板和自体股骨头植骨重建髋臼前缘骨缺损，生物型髋臼杯植入；B型，切除坐骨支及髋臼后缘，采用自体股骨头植骨，松质骨螺钉固定，对于不能维持髋臼初始稳定性者，配合使用髋臼加强环固定；C型，切除部分髂骨及髋臼上缘，采用自体股骨头植骨重建髋臼顶，使用髋臼加强环及骨水泥臼杯重建髋关节。搜集随访资料，分析假体生存期、术后并发症，术后功能的评定采用肌肉骨骼肿瘤学会（Musculoskeletal Tumor ociety，MSTS）93评分。结果20例患者均获得随访，随访时间13~56个月，平均34个月。病理类型：软骨肉瘤17例，恶性骨巨细胞瘤3例。术后3例软骨肉瘤复发，复发率为15%，1例恶性骨巨细胞瘤复发并发生肺转移。髋臼假体早期脱位2例，给予闭合复位后髋关节支具固定6周治疗；假体松动1例，给予髋臼侧翻修；深部感染1例，采用清创后假体取出并旷置治疗。2例自体股骨头移植生物全髋关节置换患者髋臼愈合良好。术后功能MSTS 93评分中优13例、良6例、差1例。结论根据肿瘤的性质决定肿瘤的切除方式和范围是肿瘤获得良好肿瘤学预后的关键，在保证肿瘤切除范围的前提下，根据髋臼上缘肿瘤分型个体化重建是获得良好功能及假体生存率的要点。

Objective -Investigate the surgical resection, reconstruction technique and follow-up of partly defect by pri- mary bone malignancy in acetabulum. Methods Retrospective analysis 20 cases clinical data of partly defect by primary bone malignancy in acetabulum patients from January 2009 to January 2015. Resect the tumor and reconstruct the acetabulum based on the type of acetabulum tumor： type A, excise pubis and partial acetabulum, use serf-femoral-head transplantation and pelvis recon- struct steels to reconstruct the bone defection of acetabulum leading edge, then transplant biological type acetabular cup; type B, excise ischium and trailing edge of acetabulum, transplant self-femoral-head and fixed with cancellous screw, for those can＇ t main- tain the acetabulum stabilization, apply acetabulum enhance ring to immobilize; type C, excise partial ilium and acetabulum supe- rior margo to interrupt its discontinuity, self-femoral-head transplant to reconstruct acetabulum, then use enhance ring and cement- ed cup to rebuild hip joint. Results Total 20 cases, 13 males and 7 females; the age ranges 23-69 years old, average 48 years; followed up 13-56 months, mean 34 months. Pathology types： 17 cases of chondrosarcoma and 3 cases of malignant bone giant cell tumor. After surgery, 3 cases of chondrosarcoma recurred （15%）, 1 case of malignant bone giant cell tumor relapsed and devel- oped to pulmonary metastasis. 2 cases of acetabulum prosthesis incipient dislocation performed closed replacement then fixed 6 weeks with hip joint brace. 1 cases of prosthesis losing performed hip joint revision. 1 case occurred deep hip infection, which per- formed debridement and taking out prosthesis. 2 cases self-femoral-head transplant and biological total hip replacement healed well. Postoperative functional MSTS 93 score showed excellent in 13 cases, good in 6 cases, poor in 1 case. Conclusion Accord- ing to the tumor type and range, determine the resection method and boundary, which is the key to acquire well oncological progno- sis. On the premise of sufficient tumor resection, reconstruct function individually based on the type of acetabulum tumor, which is the key to acquire well functional prognosis and prosthesis survival rate.