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目的探讨髋臼周围肿瘤切除组配式半骨盆假体置换术中髋关节旋转中心的定位及临床意义。方法2004年1月至2014年1月我院行骨盆肿瘤切除组配式半骨盆假体重建患者42例,以国际肌肉骨骼肿瘤协会评分(MSTS评分)评估术后功能,并分析患者术后并发症、生存率及复发率等效果。测量假体髋关节旋转中心的位置,以理想旋转中心的位置作参照,在水平方向上将其分成内移组、正常组和外移组,在纵轴方向上将其分为上移组、正常组和下移组等亚组,并分析假体髋关节旋转中心的偏移与患者术后1月、3月、6月和12月功能的关系。结果共随访分析42例患者,男性25例,女性17例。年龄12~69岁,平均年龄38岁。随访时间12~86月,平均随访36月。术后并发症发生率31.0%,髋关节脱位发生率7.1%。3年生存率69.4%、5年生存率43.7%。术后1月、3月、6月功能逐渐好转,MSTS评分呈递增趋势,3个时间点的MSTS评分比较,差异有统计学意义(P<0.05);术后6月、12月功能改善不明显,差异无统计学意义(P>0.05)。髋关节旋转中心定位在纵轴方向及水平方向上均不影响患者术后功能(P>0.05)。结论将假体固定在最易牢固固定、软组织可充分覆盖、髋周肌肉易于重建和股骨偏心距得到一定程度恢复的位置,组配式半骨盆假体治疗骨盆肿瘤疗效满意,髋关节旋转中心的位置与术后功能的关系仍需要进一步的证据加以明确。
Objective To investigate the location and clinical significance of the hip joint center of rotation in the semi-pelvic prosthesis replacement with acetabular tumor resection. Methods From January 2004 to January 2014, 42 patients with pelvic tumor resection combined with pelvic pelvic prostheses in our hospital were evaluated with the International Musculoskeletal Tumor Association (MSTS) score to evaluate the postoperative function and to analyze the postoperative complications Symptoms, survival and recurrence rate and other effects. The position of the center of rotation of the hip joint was measured. The position of the ideal center of rotation was used as a reference. The horizontal axis was divided into internal shift group, normal group and external shift group. Normal group and down-shift group, and analyzed the relationship between the deviation of the rotation center of hip joint and the function of patients in January, March, June and December after operation. Results A total of 42 patients were followed up, including 25 males and 17 females. Aged 12 to 69 years old, average age 38 years old. Follow-up time was 12 to 86 months with an average follow-up of 36 months. The incidence of postoperative complications was 31.0% and the incidence of hip dislocation was 7.1%. The 3-year survival rate was 69.4% and the 5-year survival rate was 43.7%. MSTS score showed an increasing trend after 1 month, 3 months and 6 months. There was significant difference in MSTS score between the 3 time points (P <0.05); after 6 months and 12 months, the function improvement was not Obviously, the difference was not statistically significant (P> 0.05). Hip rotation center positioning in the longitudinal axis and horizontal direction did not affect the patient’s postoperative function (P> 0.05). Conclusion The prosthesis is fixed in the position which is the most easily fixable, soft tissue can be fully covered, the hip muscle is easy to reconstruct and the femoral eccentricity is recovered to a certain extent. The hemoblasts are effective in treating pelvic tumors, The relationship between location and postoperative function still needs further evidence to be clarified.