髂骨周围恶性肿瘤切除后不同重建方法比较

Comparison of different reconstruction methods after resection of malignant tumors around the ilium

目的观察髂骨周围(Ⅰ区、Ⅰ+Ⅱ区、Ⅰ+Ⅳ区)恶性肿瘤的切除、不同重建方法的临床效果。方法回顾性分析2012年1月至2017年12月山西医科大学第二医院收治的23例髂骨周围恶性肿瘤切除后重建患者的临床资料。所有患者均进行了骨盆肿瘤切除钉棒系统以及半骨盆重建,部分患者同时进行了植骨或骨水泥强化。对患者的临床效果、生存率、并发症、肢体功能评分进行统计学分析。结果所有患者均获随访,中位随访时间42个月(10~79个月)。11例生存,1年总生存(OS)率82.6%(19/23)、3年OS率65.2%(15/23)、5年OS率52.2%(12/23);未涉及髋臼者3年OS率70.6%,涉及髋臼者3年OS率57.1%,两组比较差异有统计学意义(χ^2=4.182,P=0.041);合并有伤口不愈合、脱位等并发症共7例患者;椎弓根钉棒固定重建方式患者术后功能评分(23.6±1.3)分,普通半骨盆及钉棒半骨盆重建患者术后功能评分(18.1±1.4)分,差异有统计学意义(t=9.42,P<0.01)。结论髂骨周围肿瘤切除后的骨缺损,椎弓根钉棒固定重建的临床效果优于钉棒半骨盆重建。

Objective To observe the clinical effects of resection and different reconstruction methods of malignant tumors around the ilium(Ⅰregion,Ⅰ+Ⅱregion andⅠ+Ⅳregion).Methods The clinical data of 23 patients with resection and reconstruction of malignant tumors around the ilium in the Second Hospital of Shanxi Medical University from January 2012 to December 2017 was retrospectively analyzed.All patients received pelvic tumor resection and screw-rod system fixation,and some patients received bone graft or cement reinforcement at the same time.The clinical effect,survival rate,complications and limb function score were statistically analyzed.Results All cases were followed up for 10-79 months(median 42 months).Eleven patients survived,the 1-year overall survival(OS)rate was 82.6%(19/23),the 3-year OS rate was 65.2%(15/23),and the 5-year OS rate was 52.2%(12/23).The 3-year OS rate was 70.6%for the patients without acetabulum involvement,and 57.1%for those with acetabulum involvement,and the difference between the two groups was statistically significant(χ^2=4.182,P=0.041).Seven cases complicated with wound nonunion,dislocation and other complications.The postoperative functional score of patients with pedicle screw-rod fixation and reconstruction was(23.6±1.3)points,and the postoperative functional score of patients with ordinary semi-pelvis and nail-rod semi-pelvic reconstruction was(18.1±1.4)points,and the difference between the two groups was statistically significant(t=9.42,P<0.01).Conclusion For the bone defect after resection of tumors around the ilium,the clinical effect of pedicle screw-rod fixation is better than that of nail-rod semi-pelvic reconstruction.