摘要
目的探讨骨盆Ⅱ区肿瘤完整切除及采用同种异体骨盆、组配式假体、3D打印假体重建的疗效。方法回顾分析2011年3月—2022年3月收治的13例原发恶性骨肿瘤累及骨盆Ⅱ区,行肿瘤完整切除及髋臼重建术患者临床资料。男4例,女9例;年龄16~59岁,平均39.0岁。骨巨细胞瘤4例、软骨肉瘤5例、骨肉瘤2例、尤文肉瘤2例。骨盆肿瘤Enneking分区:肿瘤累及Ⅱ区4例,累及Ⅰ区和Ⅱ区4例,累及Ⅱ区和Ⅲ区5例。病程1~24个月,平均9.5个月。随访观察肿瘤有无复发、转移;影像学检查观察内植物在位、断裂,骨吸收、骨不愈合等情况。术前及术后1周采用疼痛视觉模拟评分(VAS)评价患者髋关节疼痛改善情况;术后根据国际肌肉骨骼肿瘤学会(MSTS)评分标准评价髋关节功能恢复情况。结果手术时间4~7 h,平均4.6 h;术中出血量800~1600 mL,平均1200.0 mL。术后无再次手术或死亡患者。13例均获随访,随访时间9~60个月,平均33.5个月。4例接受化疗患者随访期间未发现肿瘤转移。术后1例出现创面感染;1例假体置换术后1个月发生假体脱位。1例骨巨细胞瘤术后12个月复发,穿刺活检提示骨巨细胞瘤恶变,行半骨盆截肢。术后患者髋关节疼痛均较术前明显改善,术后1周VAS评分为(6.1±0.9)分,与术前(8.2±1.3)分比较差异有统计学意义(t=9.699,P<0.001)。术后12个月MSTS评分为(23.0±2.1)分,其中同种异体骨盆重建患者为(22.8±2.1)分、假体重建患者为(23.3±2.3)分,两种重建方式MSTS评分比较差异无统计学意义(t=0.450,P=0.516)。末次随访时5例患者手杖辅助行走,7例无辅助行走。结论原发骨盆Ⅱ区肿瘤切除重建可获得较满意髋关节功能;同种异体骨盆、3D打印假体界面有较好的骨长入,更符合生物力学与生物重建要求。但骨盆重建手术难度较大,术前应全面评估病情;远期疗效有待进一步随访。
Objective To investigate the effectiveness of complete resection of bone tumor in pelvic zoneⅡand reconstruction with allogeneic pelvis,modular prosthesis,and three-dimensional(3D)printing prosthesis.Methods The clinical data of 13 patients with primary bone tumor in pelvic zoneⅡwho underwent tumor resection and acetabular reconstruction between March 2011 and March 2022 were retrospectively analyzed.There were 4 males and 9 females with an average age of 39.0 years ranging from 16 to 59 years.There were 4 cases of giant cell tumor,5 cases of chondrosarcoma,2 cases of osteosarcoma,and 2 cases of Ewing sarcoma.The Enneking classification of pelvic tumors showed that 4 cases involved zoneⅡ,4 cases involved zoneⅠand zoneⅡ,and 5 cases involved zoneⅡand zoneⅢ.The disease duration ranged from 1 to 24 months,with an average of 9.5 months.The patients were followed up to observe the recurrence and metastasis of the tumor,and the imaging examination was performed to observe the status of implant in place,fracture,bone resorption,bone nonunion,and so on.The improvement of hip pain was evaluated by visual analogue scale(VAS)score before operation and at 1 week after operation,and the recovery of hip function was evaluated according to the Musculoskeletal Tumor Society(MSTS)scoring system after operation.Results The operation time was 4-7 hours,with an average of 4.6 hours;the intraoperative blood loss ranged from 800 to 1600 mL,with an average of 1200.0 mL.There was no reoperation or death after operation.All patients were followed up 9-60 months(mean,33.5 months).No tumor metastasis was found in 4 patients receiving chemotherapy during follow-up.Postoperative wound infection occurred in 1 case,and prosthesis dislocation occurred in 1 case at 1 month after prosthesis replacement.One case of giant cell tumor recurred at 12 months after operation,and the puncture biopsy showed malignant transformation of giant cell tumor,and hemipelvic amputation was performed.The postoperative hip pain significantly relieved,and the VAS score was 6.1±0.9 at 1 week after operation,which was significantly different from the preoperative score(8.2±1.3)(t=9.699,P<0.001).At 12 months after operation,the MSTS score was 23.0±2.1,including 22.8±2.1 for patients with allogenic pelvis reconstruction and 23.3±2.3 for patients with prosthsis reconstruction.There was no significant difference in the MSTS score between the two reconstruction methods(t=0.450,P=0.516).At last follow-up,5 patients could walk with cane assistance and 7 patients could walk without cane assistance.Conclusion The resection and reconstruction of primary bone tumor in pelvic zoneⅡcan obtain satisfactory hip function,and the interface of allogeneic pelvis and 3D printing prosthesis have better bone ingrowth,which is more in line with the requirements of biomechanics and biological reconstruction.However,pelvis reconstruction is difficult,the patient’s condition should be evaluated comprehensively before operation,and the long-term effectiveness needs further follow-up.
作者
黄俊琪
程佳佳
王陶
许猛
韩纲
贾金鹏
王威
屠重棋
毕文志
HUANG Junqi;CHENG Jiajia;WANG Tao;XU Meng;HAN Gang;JIA Jinpeng;WANG Wei;TU Chongqi;BI Wenzhi(Department of Orthopedics,Mianyang Central Hospital,Mianyang Sichuan,621000,P.R.China;Department of Orthopedics,the Fourth Medical Center of Chinese PLA General Hospital,Beijing,100853,P.R.China;Department of Orthopedics,West China Hospital,Sichuan University,Chengdu Sichuan,610041,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2023年第3期277-283,共7页
Chinese Journal of Reparative and Reconstructive Surgery
基金
国家自然科学基金面上项目(81472513)
绵阳市中心医院孵化课题(2019FH15)。
关键词
骨盆
髋臼
骨肿瘤
重建
Pelvis
acetabulum
bone tumor
reconstruction
