论文部分内容阅读
[目的]探讨半骨盆置换术在骨盆恶性肿瘤广泛切除和功能性保肢手术中的应用。[方法]回顾本科自2003～2007年16例半骨盆切除和重建手术治疗案例,评估骨盆恶性肿瘤广泛切除和假体置换术的疗效和并发症。[结果]16例骨盆原发性恶性骨肿瘤患者,接受了骨盆肿瘤切除和计算机辅助定制人工半骨盆假体置换手术。患者平均年龄为27岁,病理类型包括4例骨肉瘤、6例软骨肉瘤、3例骨巨细胞瘤、1例尤文肉瘤和2例纤维肉瘤,外科分期为ⅡB。术前评估包括:MRI、ECT全身骨扫描、肺部CT、肿瘤穿刺活检及动脉血管造影并根据病理结果部分行动脉灌注化疗,广泛切除骨盆肿瘤,安装定制人工半骨盆假体。术中平均出血2 600 ml(1 200～8 500 ml)。5例有伤口并发症,脱位3例。中位随访时间36个月(23～62个月),3例局部复发行局部切除放疗,4例死于原发肿瘤远处转移,MSTS功能评分平均72%。[结论]在骨盆原发性恶性肿瘤的治疗中,合理的广泛切除是治愈肿瘤的关键,应用计算机辅助半骨盆假体置换能快速、有效重建骨骼缺损,原发肿瘤对化疗及放疗的敏感性及肿瘤的性质是决定预后的主要原因,伤口并发症及脱位是其主要并发症,患者心理满意度较高,患肢功能可以接受。
[Objective] To explore the application of semi-pelvic replacement in extensive resection of pelvic malignant tumor and functional limb salvage surgery. [Methods] From 2003 to 2007, 16 cases underwent resection and reconstruction of the semi-pelvis and evaluate the curative effect and complications of extensive resection and prosthesis replacement. [Results] 16 patients with pelvic primary malignant bone tumor underwent pelvic tumor resection and computer-assisted custom artificial pelvis pelvic replacement surgery. The mean age of patients was 27 years old. The pathological types included 4 cases of osteosarcoma, 6 cases of chondrosarcoma, 3 cases of giant cell tumor of bone, 1 case of Ewing’s sarcoma and 2 cases of fibrosarcoma. The surgical stage was stage IIB. Preoperative evaluation included: MRI, whole body bone scan of ECT, CT of lung, biopsy of tumor and arterial angiography. According to the results of pathology, part of artery was infused into chemotherapy, extensive resection of pelvic tumor, and installation of customized artificial pelvis pelvic prosthesis. Intraoperative bleeding average 2 600 ml (1 200 ~ 8 500 ml). 5 cases had wound complications, dislocation in 3 cases. The median follow-up time was 36 months (range, 23-62 months). Three patients underwent local resection with local excision radiotherapy and four patients died of primary tumor distant metastasis. The mean MSTS score was 72%. [Conclusion] In the treatment of pelvic primary malignant tumor, reasonable and extensive excision is the key to cure the tumor. The application of computer-assisted semi-pelvic prosthesis replacement can quickly and effectively reconstruct the bone defect and the sensitivity of the primary tumor to chemotherapy and radiotherapy And the nature of the tumor is the main reason for determining the prognosis. Wound complications and dislocation are the main complication. Patients with high psychological satisfaction, limb function acceptable.