Surgical resection and reconstructive techniques using autologous femoral head bone-grafting in treating partial acetabular defects arising from primary pelvic malignant tumors
Surgical resection and reconstructive techniques using autologous femoral head bone-grafting in treating partial acetabular defects arising from primary pelvic malignant tumors
复制标题
自体股骨头植骨手术切除重建技术治疗原发性盆腔恶性肿瘤引起的部分髋臼缺损
DOI：
10.1186/s12885-019-6196-x
复制
发表时间：
2019-10-18
期刊：
影响因子：
3.8
通讯作者：
Cai, Zhengdong
中科院分区：
文献类型：
--
作者：
Sun, Wei;Zan, Pengfei;Cai, Zhengdong
本研究的目的是介绍和评估自体股骨头植骨手术切除和重建技术治疗原发性骨盆恶性肿瘤引起的部分髋臼缺损。方法回顾性分析2009年1月至2015年1月20例累及髋臼的原发性盆腔恶性肿瘤。根据肿瘤类型进行手术切除和重建，采用自定义截骨导具和自体股骨头植骨。收集并分析所有病例的假体生存期、并发症发生情况和临床结局数据。结果男性13例，女性7例，平均年龄48岁（23 ~ 69岁），中位随访时间为69个月（48 ~ 112个月）。在这些病例中，17例包括软骨肉瘤，另外3例经病理证实为骨恶性巨细胞瘤（MBGCT）。随访期间，3例软骨肉瘤复发（15%），其中2例行半盆腔截肢，1例MBGCT复发并发生肺转移。2例髋臼假体发生临发脱位，行闭合复位后髋外展支具固定6周。修复1例假体松动。另一例深度感染发生于清创和假体移除。采用肌肉骨骼肿瘤学会1993 （MSTS-93）评分进行功能评价：良好13例，一般6例，差1例。结论截骨术的精确性对骨重建策略的成功至关重要。在髋臼截骨和股骨头重建术中使用定制导具可以改善功能预后，在中期随访期间并发症相对较低。
BackgroundThe aim of this study is to present and evaluate surgical resection and reconstructive techniques using autologous femoral head bone-grafting in treating partial acetabular defects arising from primary pelvic malignant tumors.MethodsFrom January 2009 until January 2015, a total of 20 primary pelvic malignancy cases involving the acetabulum were retrospectively investigated. Surgical resections and reconstructions were conducted based on the type of the tumor with custom osteotomy guides and autologous femoral head bone-grafting. In all cases, prosthesis survival period, complication occurrence, and clinical outcomes data were collected and analyzed.ResultsThirteen male and 7 female patients with an average age of 48 years old (range 23-69 years old) were followed for a median of 69 months (range 48-112 months). Of these cases, 17 included chondrosarcomas and 3 additional patients with a malignant giant cell tumor of bone (MBGCT) as proven by pathology. During follow-up, 3 cases of chondrosarcoma recurred (15%), of which two cases received hemi-pelvic amputation, 1 case of MBGCT relapsed and developed pulmonary metastases. Two cases of acetabular prosthesis with an impending dislocation received closed reduction followed by 6 weeks of hip abduction brace fixation. One case of prosthesis loosening was revised. In another case a deep infection occurred with debridement and prosthesis removal. Musculoskeletal Tumor Society 1993 (MSTS-93) score was utilized to conduct functional evaluation: 13 cases were good, 6 were average and one was poor.ConclusionThe precision of the osteotomies performed is likely crucial for this type of reconstructive strategy to be successful. The use of custom guides for acetabular osteotomies and femoral head reconstruction can improve functional outcomes with relatively low complications at the intermediate length of follow-up.