经皮中空螺钉内固定联合骨水泥成形术治疗髋臼周围转移瘤

Percutaneous hollow screw internal fixation combined with cementoplasty in treatment of periacetabular metastasis

目的探讨经皮中空螺钉内固定联合骨水泥成形术治疗髋臼周围转移瘤的疗效。方法回顾性分析2020年5月—2021年5月,采用经皮中空螺钉内固定联合骨水泥成形术治疗的16例髋臼周围转移瘤患者临床资料。男9例,女7例;年龄40~73岁,平均53.6岁。肿瘤累及髋臼周围,左侧6例、右侧10例。记录手术时间、术中透视次数、患者术后下地时间及并发症发生情况。术前及术后1周、3个月采用疼痛视觉模拟评分(VAS)评估患者疼痛程度,简明健康调查量表(SF-36量表)评估生活质量;术后3个月采用美国骨与软组织肿瘤学会(MSTS)评分评价患者术后功能恢复情况。随访期间X线片复查有无骨水泥渗漏、内固定物松动等情况发生。结果患者手术均顺利完成。手术时间57~82 min,平均70.4 min;术中透视16~34次,平均23.1次。术后发生1例切口血肿,1例阴囊水肿。患者自觉疼痛缓解,术后1~3 d开始下地活动,平均1.4 d。患者均获随访,随访时间6~12个月,平均9.7个月。术后VAS评分及SF-36量表评分均较术前改善,且术后3个月优于1周,差异均有统计学意义(P<0.05)。术后3个月MSTS评分为9~27分,平均19.8分;其中优3例(18.75%)、良8例(50%)、可3例(18.75%)、差2例(12.5%),优良率达68.75%。11例患者恢复正常行走,3例轻度跛行,2例明显跛行。影像学复查示术后出现2例骨水泥渗漏;所有患者均无内固定物松动、移位等情况发生。结论经皮中空螺钉内固定联合骨水泥成形术治疗髋臼周围转移瘤能有效缓解疼痛,提高患者生活质量。

Objective To explore the percutaneous hollow screw internal fixation combined with cementoplasty in the treatment of periacetabular metastasis.MethodssAretrospective studywas performed on16patientswith periacetabular metastasis who were treated with percutaneous hollow screw internal fixation combined with cementoplasty between May 2020 and May 2021.There were 9 males and 7 females.The age ranged from 40 to 73 years,with an average of 53.6 years.The tumor involved around the acetabulum,and 6 cases were located on the left and 10 cases on the right.Operation time,frequency of fluoroscopy,bed rest time,and complications were recorded.Before operation,and at 1 weeks,3 months after operation,the visual analogue scale(VAS)score was used to evaluate the pain degree,the short-form 36 health survey scale(SF-36)score was used to evaluate the quality of life.At 3 months after operation,the Musculoskeletal Tumor Society(MSTS)scoring system was used to evaluate the functional recovery of patients.During follow-up,the loosening of internal fixator and bone cement leakage were observed by X-ray film.ResultsAll patients were performed operation successfully.The operation time ranged from 57 to 82 minutes,with an average of 70.4 minutes.The frequency of intraoperative fluoroscopy was 16-34 times,with an average of 23.1 times.After operation,1 case of incision hematoma and 1 case of scrotal edema occurred.All patients felt the pain relieved after operation.The patients started walking at 1-3 days after operation,with an average of 1.4 days.All patients were followed up 6-12 months(mean 9.7 months).The VAS and SF-36 scores significantly improved after operation when compared with the preoperative scores,and the scores at 3 months after operation were significant better than those at 1 week fter operation(P<0.05).At 3 months after operation,the MSTS score ranged from 9 to 27,with an average of 19.8.Among them,3 cases were excellent(18.75%),8 cases were good(50%),3 cases were fair(18.75%),and 2 cases were poor(12.5%).The excellent and good rate was 68.75%.And 1l patients returned to normal walking,3 had mild claudication,and 2 had obvious claudication.Radiological examination showed that there were 2 cases of bone cement leakage after operation,and there was no internal fixator loosening or displacement.Conclusion Percutaneous hollow screw internal fixation combined with cementoplasty can effectively relieve pain and improve the quality of life of patients with periacetabular metastasis.