带骶骨钩设计承载式半骨盆假体的疗效分析

摘要

Objective To evaluate the safety and effectiveness of a novel modular hemipelvic endoprosthesis with a sacral hook.Methods Fifty-three patients (31 males and 22 females; average age,28 years) diagnosed with pelvic tumor from 2003 to 2014 were retrospectively studied.Pathological diagnoses included 22 osteosarcomas,12 Ewing's sarcomas,8 chondrosarcomas,6 metastatic malignancies,3 fibrosarcomas and 2 giant cell tumors.Initial tumor location included 23 cases of region Ⅰ+Ⅱ,12 cases of region Ⅱ+Ⅲ and 18 cases of region Ⅰ+Ⅱ+Ⅲ.All primary tumors were staged Ⅱ B according to Enneking's staging.All patients received limb-salvage surgery and reconstruction using the novel modular hemipelvic endoprosthesis with a sacral hook.Results All of 53 patients were followed for an average of 51.8 months (6-112 months).At the most recent follow-up,35 patients (66.0％) were alive,with a mean survival time of 70.6 months according to Kaplan-Meier survival analysis.18 patients (34.0％)died of tumor,with a mean survival of 28 months,and 9 patients (17.0％) experienced local recurrence at an average of 23.6months after surgery.Patients with marginal or intracapsular surgical margins had a significantly higher recurrence rate (30.4％)than those with wide margins (6.7％).Metastasis occurred in 12 cases at an average of 16 months (6-40 months) after surgery,and all patients with metastases died except one living with tumor.The total perioperative complication rate was 50.9％,including 15 cases (28.3％) of wound healing disturbances,8 cases (15.1％) of deep infection,1 case of posterior urethra injury,1 case of sciatic nerve injury,1 case of deep vein thrombosis and 1 case of pulmonary embolism.The endoprosthetic complication rate was 15.1％,including 5 cases of pubic connection plate breakage,2 cases of hip joint dislocation and 1 case of aseptic loosening of the sacral connection part.Five revision surgeries were performed for 2 septic failures and 3 aseptic failures.The estimated three year survival rate of the endoprosthesis reached 89.0％.The mean Musculoskeletal Tumor Society (MSTS 93) score was 18.2 (60.7％).Conclusion Reconstruction using the novel modular hemipelvic endoprosthesis with a sacral hook is safe and effective,whose function was satisfactory with a relatively low prosthetic complication rate.%目的 评价一种自行设计带骶骨钩的承载式半骨盆假体的安全性和有效性.方法 回顾性分析2003年至2014年期间就诊于中山大学附属第一医院骨肿瘤科的53例骨盆肿瘤患者的病例资料,男31例,女22例;平均年龄28岁.骨肉瘤22例、Ewing肉瘤12例、软骨肉瘤8例、转移瘤6例、纤维肉瘤3例、复发性巨大骨巨细胞瘤2例.23例侵犯骨盆Ⅰ、Ⅱ区,12例侵犯Ⅱ、Ⅲ区,18例同时侵犯Ⅰ、Ⅱ、Ⅲ区.所有原发肿瘤Enneking分期均为ⅡB期.均接受肿瘤切除后应用带骶骨钩设计的人工半骨盆假体重建术.结果 53例患者均得到随访,随访时间6～112个月,平均为51.8月.至末次随访53例患者中35例(66.0％)仍存活,Kaplan-Meier法计算平均生存期为70.6月;18例(34.0％)死亡,平均为术后28个月.9例肿瘤局部复发,复发率为17.0％,平均发生在术后23.6个月,其中肿瘤边缘或囊内切除者复发率(30.4％)明显高于广泛切除者(6.7％).12例(22.6％)患者术后平均16个月(6～40个月)发生远处转移,除1例带瘤生存外均已死亡.围手术期并发症总发生率为50.9％,包括15例(28.3％)切口愈合不良,8例(15.1％)深部感染,1例后尿道损伤,1例坐骨神经损伤,1例深静脉血栓形成及1例肺动脉栓塞.假体并发症发生率为15.1％,包括5例耻骨支假体断裂,2例人工关节脱位及1例骶骨连接部件无菌性松动.5例(9.4％)接受假体翻修,其中2例为感染导致,3年假体生存率为89.0％.53例患者术后国际骨肿瘤协会(Musculoskeletal Tumor Society,MSTS 93)评分平均为18.2分(60.7％).结论 带有骶骨钩设计的承载式人工半骨盆假体是一种骨盆肿瘤切除后安全、有效的重建假体,术后肢体功能满意,假体并发症发生率较低.