骨盆自体瘤骨灭活再植重建术的临床应用研究

Clinical application of pelvic autogenous bone tumor inactivated replantation

目的探讨骨盆肿瘤患者接受自体瘤骨灭活再植重建手术后的并发症、下肢功能及预后情况。方法分析2010年1月至2015年12月在驻马店市中心医院接受自体瘤骨灭活再植手术治疗的13例骨盆肿瘤患者的临床资料。手术切除肿瘤,去除骨外肿瘤包块,刮除松质骨内肿瘤,将残余骨壳放入65℃20%高渗氯化钠溶液中灭活30 min,原位植入灭活骨,螺钉、钢板内固定。累及骶髂关节者采用椎弓根钉同定系统加固,累及髋臼者行全髋关节置换,髋臼破坏严重时用带翼网杯、钛网杯加固,必要时采用骨水泥填充提高骨强度。结果手术时间4.0~8.5 h,平均5.7 h;术中出血量820~5 000 ml,平均3 500 ml。术后1例失访,其余随访6~78个月,中位随访时间31个月。5例复发,远处转移3例;骨折和关节脱位各1例;浅表感染3例。截至随访终点,4例无瘤存活,3例带瘤生存,5例死亡。7例存活者灭活骨愈合情况ISOLS评分为38.0%~93.0%,中位评分为81.0%;下肢功能MSTS评分为23.0%~91.0%,中位评分为60.0%。结论肿瘤骨灭活再植术后虽然肿瘤复发率较高,但对预期生存期较长的患者仍不失为一种重要的治疗手段,应权衡利弊,把握手术适应证。

Objective To investigate the complications, lower extremity function and prognosis of pa- tients with pelvic tumor undergoing inactivated autologous bone replantation. Methods The clinical data of 13 patients with pelvic tumors treated with inactivated autologous bone replantation in Zhumadian Central Hospital from January 2010 to December 2015 were retrospectively analyzed. Surgical resection of the tumor, the tumor removal of bone mass, and curettage of cancellous bone tumor were performed, and the residual bone shell was inactivated into 20% hypertonic saline solution for 30 min at 65 ℃. Orthotopic implantation of inactivated bone was performed, with screw and plate fixation. In pelvic tumor involving the sacroiliac joint we used pedicle screw fixation with reinforcement system. In pelvie tumor involving the acetabulum, total hip arlhroplasty was performed. When the acetahular was severely damaged, the cup was strengthened with wing net cup and titani- um mesh reinforcement. If necessary, use the bone cement filling to improve bone strength. Results The operation time ranged from 4 to 8.5 h, with an average of 5.7 h, and the intraoperative blood loss ranged from 820 5000 ml, with an average of 3 500 ml. One case was lost, the rest of patients were followed up for 6 - 78 months with the median follow-up of 31 months. There were 5 cases of recurrence, 3 of distant metastasis, 1 of fracture, 1 of joint dislocation, and 3 of superficial infection. Up to the end of follow-up, 4 cases survived with- out tumor, 3 cases survived with tumor, and 5 cases died. The inactivated bone healing ISOLS scores of 7 survi- vors ranged from 38% to 93% with the median score of 81%. The lower limb function MSTS scores ranged from 23% - 91% with the median score of 60%. Conclusion Although there is a high tumor recurrence rate after treatment of bone tumor inactivation and replantation, it is still an important treatment for patients with expected longer survival. The benefits should be weighed according to surgical indications.