Resection and Reconstruction of Pelvic Bone Tumors
Resection and Reconstruction of Pelvic Bone Tumors
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DOI：
10.3928/01477447-20150204-51
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发表时间：
2015-02-01
期刊：
影响因子：
1.1
通讯作者：
Ruggieri, Pietro
中科院分区：
文献类型：
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作者：
Angelini, Andrea;Calabro, Teresa;Ruggieri, Pietro
本研究的目的是评估骨盆骨肿瘤保肢重建术后的结局和复发率，并分析并发症及其与手术的关系。作者分析了129例患者，平均随访6年（范围：2-19年）。软骨肉瘤是最常见的组织型。31例无髋臼受累者仅行同种异体骨重建。采用同种异体骨假体复合材料（n=60）、仅同种异体骨（n=11）、骨小梁金属组件（n=2）、仅假体（n=10）、鞍形假体（n=11）和髂股关节融合术（n=1）重建髋臼切除。边缘较宽（n=94）、广泛污染（n=22）、边缘（n=7）和病灶内（n=6）。肿瘤学结局如下：75例患者持续无病，6例复发治疗后无病，13例带病生存，28例死于疾病，5例死于其他原因。10年生存率为66%。恶性肿瘤的局部复发率为22.1%，与切缘（P= 0.140）或部位（P= 0.933）无统计学影响。转移率为32.8%。在30例（23.6%）病例中观察到深部感染，使用和不使用同种异体移植物的重建之间无统计学差异（P= 0.09）。16例行外半骨盆切除术。使用带柄髋臼杯或多孔金属部件结合同种异体骨进行重建的新技术现在可用。盆腔肿瘤的局部控制和满意的长期生存是可以实现的，但这种手术意味着高并发症的发生率。感染是主要并发症，不受同种异体移植物使用的影响。很少需要截肢。
The objective of this study was to assess outcome and recurrence rate after limb-salvage surgery with reconstruction for pelvic bone tumors and analyze complications and their relationship with surgery. The authors analyzed 129 patients followed for a mean of 6 years (range, 2-19 years). Chondrosarcoma was the most frequent histotype. Thirty-one cases with no acetabular involvement were reconstructed with allograft only. Acetabular resections were reconstructed with allograft prosthetic composite (n=60), allograft only (n=11), trabecular metal components (n=2), prosthesis only (n=10), saddle prosthesis (n=11), and iliofemoral arthrodesis (n=1). Margins were wide (n=94), wide contaminated (n=22), marginal (n=7), and intralesional (n=6). Oncologic outcomes were as follows: 75 patients were continuously disease free, 6 were disease free after treatment of relapse, 13 were alive with disease, 28 were dead of disease, and 5 were dead of other causes. Survival was 66% at 10 years. Local recurrence rate of malignant tumors was 22.1% and was not statistically influenced by margins (P=.140) or site (P=.933). Metastasis rate was 32.8%. Deep infection was observed in 30 (23.6%) cases, with no statistical difference between reconstructions with and without allograft (P=.09). Final external hemipelvectomy was performed in 16 cases. Newer techniques of reconstruction using stemmed acetabular cups or porous metal components combined with allograft are now available. Local control and satisfactory survival is achievable long term in patients with pelvic tumors, but this surgery implies a high rate of complications. Infection is a major complication, not influenced by the use of allografts. Amputation is rarely needed.