摘要
目的探讨骨盆肿瘤的切除与重建方式。方法1991年7月～2006年12月,20例骨盆肿瘤患者接受骨盆肿瘤切除手术,其中18例又接受重建手术。男12例,女8例。软骨肉瘤9例,骨巨细胞瘤5例,尤文氏肉瘤1例,骨嗜酸性肉芽肿1例,腺泡状肉瘤1例,转移癌3例。根据Enneking骨盆肿瘤分区:I区7例,II区8例,III区5例。I区的2例切除范围较局限未重建。重建方法为I区肿瘤切除后使用自体腓骨重建2例,斯氏钉+骨水泥重建1例,钢板+骨水泥重建2例。II区的肿瘤切除后4例行股骨头旷置,2例行人工半骨盆置换,2例行钢板、骨水泥+人工全髋关节植入方式重建。III区的肿瘤切除后,5例均采用钢板+骨水泥重建。术后随访3个月～15年。结果局部复发5例,再次接受复发灶切除2例,放弃治疗3例。所有股骨头旷置病例均无复发。死亡6例。侵犯I、III区的肿瘤切除后,患者步态基本正常。侵犯II区的肿瘤切除后行人工半骨盆置换或行钢板、骨水泥+人工全髋关节植入的患者,半年后行走基本正常。接受股骨头旷置的患者,有较满意的活动度,行走时跛行。结论骨盆肿瘤切除重建的原则是首先完整切除肿瘤,然后再作功能重建。重建方式的选择应考虑各种方法的优缺点,尽量减少并发症的发生。
Objective To explore the techniques for the resection and reconstrutiothe of pelvic tumor. Methods Twenty patients with pelvic tumors underwent surgical treatment from July 1997 through December 2003. Pelvic reconstrution was performed in 18 cases . Twelve paitents were males and 8 females. The pathological diagnosis was as follows： chondrosarcoma in 9 cases, giant cell tumor（GCT） in 5, Ewing＇sarcoma in 1, eosinophilic granuloma in 1, alveolar bone sarcoma in 1 and metastatic carcinoma in 3. According to Enneckning＇division, zone I was categerized in 7 cases, zone Ⅱ in 8 , zone Ⅲ in 5. The resection without reconstruction was performed in 2 cases with the tumor in zone I. The reconstruction methods included： for zoneⅠ, autofibular in 2 cases, threaded pin fixation and cement filling in 1 cases, plate-secrew fixationa and ceme filling in 2 cases; for zone Ⅱ, iliofemoral arthrodesis in 4 cases, hemipelvic prosthesis in 2 cases, platesecrew fixationa and ceme filling plus total hip arthroplasty in 2 cases： for zone Ⅲ, plate-secrew fixationa and ceme filling in 5 cases. The time of followe-up ranged from 3 months to 15 years. Results local recurrence occurred in 5 c,ases and 2 among them unwent reoperation. No local recurrence occurred in patients with iliofemoral arthrodesis. Six cases died. Patients with zone Ⅰ, Ⅲ resection could walk with normal gait. Patients with zone Ⅱ resection and reconstructed by hemipelvic prosthesis, plate-secrew fixationa and ceme filling plus total hip arthroplasty could walk with nomal gait. Patients with iliofemoral arthrodesis were able to walk with abnormal gait. Conclusions The key principle of pelvis tumor resection and constrution is en bloc resection first and function reconstruction second. All the adventages and shortcomings of different reconstruction method should be taken into consideration to prevent complications.
出处
《中国骨肿瘤骨病》
2007年第6期332-336,共5页
Chinse Journal Of Bone Tumor And Bone Disease
关键词
骨盆
骨肿瘤
部分切除
重建
Pelvis
Bone neoplasms
Local resection
Reconstrution
