Extra-articular resection is a limb-salvage option for sarcoma involving the hip joint
Extra-articular resection is a limb-salvage option for sarcoma involving the hip joint
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关节外切除术是髋关节肉瘤的一种肢体挽救方案
DOI：
10.1007/s00264-018-3771-8
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发表时间：
2018-03-01
影响因子：
2.7
通讯作者：
Yang, Rongli
中科院分区：
文献类型：
--
作者：
Li, Dasen;Xie, Lu;Yang, Rongli
随着手术技术的发展和半骨盆假体系统的改进，关节外切除术可以作为一种保肢手术在选定的患者，髋关节被肉瘤侵袭。本研究的目的是描述的适应症和技术细节，术后并发症，肿瘤和功能的结果，这个programmes.18例Enneking IIB或IB肉瘤谁接受关节外切除髋关节入组。采用组配式骨盆内假体和股骨内假体联合重建骨关节缺损。病理诊断为骨肉瘤7例，软骨肉瘤7例，未分化高级别多形性肉瘤3例，恶性周围神经鞘瘤1例。1例围手术期死亡，17例随访35.0个月（10-75个月）。3例患者出现早期脱位。其中一个在三年后出现了创伤性脱位。2例患者出现伤口并发症。平均MSTS 93评分为63.5% ± 10.8%。4例局部复发。18例患者的3年无瘤生存率和总生存率均为50.0%，关节外髋关节切除术虽然技术要求高，但仍不失为一种保肢手术，值得慎重选择患者。
With the development of surgical techniques and improvements in hemi-pelvic prosthesis systems, extra-articular resection can be performed as a limb-salvage procedure in selected patients whose hip joint is invaded by a sarcoma. The aim of this study was to describe the indications for and the technical details, post-operative complications, and oncologic and functional outcomes of this procedure.Eighteen patients with Enneking IIB or IB sarcoma who underwent extra-articular resection of the hip joint were enrolled. A modular pelvic endoprosthesis combined with a femoral endoprosthesis was used to reconstruct the bone and joint defect. Pathological diagnoses included osteosarcoma (7 patients), chondrosarcoma (7), undifferentiated high-grade pleomorphic sarcoma (3), and malignant peripheral nerve-sheath tumour (1).Wide, marginal and intralesional surgical margin was achieved in 13, four and one patients, respectively. There was one peri-operative death and the other 17 patients were followed up for 35.0 months (range, 10-75 months). Three patients had early-stage dislocations. One had a traumatic dislocation three years later. Two patients had wound complications. The average MSTS 93 score was 63.5% +/- 10.8%. Four patients had local recurrence. The estimated three-year disease-free survival and overall survival for the 18 patients were both 50.0%.Although technically demanding, extra-articular resection of hip is a limb-salvage procedure that is worth considering for carefully selected patients.