骨盆肿瘤切除后同种异体骨移植重建骨盆的近期疗效  

ALLOGENEIC BONE TRANSPLANTATION FOR PELVIC RECONSTRUCTION OF LARGE SKELETAL DEFECTS AFTER TUMOR RESECTION

作　　者：王威[1] 王岩[1] 毕文志[1] 杨静[2] 韩纲[1] 贾金鹏[1] 许猛[1] 刘桂奇[1] 

机构地区：[1]解放军总医院骨科,北京1008531 [2]解放军总医院麻醉科,北京1008531

出　　处：《中国修复重建外科杂志》2014年第3期331-334,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨骨盆肿瘤切除后应用同种异体骨移植重建骨盆的近期疗效。 方法回顾性分析2008年1月－2009年11月9例骨盆肿瘤患者临床资料。男1例，女8例；年龄18～44岁，平均36.1岁。骨巨细胞瘤5例，软骨肉瘤2例，恶性骨巨细胞瘤1例，尤文肉瘤1例。根据Enneking骨盆肿瘤分区：Ⅰ区（病变累及髂骨）4例，Ⅱ区（病变累及髋臼）6例，Ⅲ区（病变累及耻骨及坐骨）3例，Ⅳ区（病变累及单侧骶骨）1例。病程1～36个月，平均6.8个月。术中完整切除肿瘤后，2例行单纯同种异体髂骨移植，6例行包括髋臼的同种异体髂骨移植，1例行同种异体骨板移植；6例行人工全髋关节置换术；1例行骶骨拉力螺钉固定骶髂关节稳定骨盆后环。 结果术后1例出现切口感染及腹胀表现，行二次清创术后切口愈合；余8例切口均Ⅰ期愈合，无感染、下肢深静脉血栓形成、脱位等围手术期并发症发生。患者均获随访，随访时间8～15个月，平均11.8个月。X线片检查示1例术后8个月发生钢板断裂；2例同种异体骨盆耻骨端部分骨吸收，其余患者假体、钢板螺钉及移植骨均在位。随访期间无死亡，无局部复发。末次随访时根据国际肌肉骨骼肿瘤学会（MSTS）肿瘤功能评分标准达18～29分，平均23分。 结论同种异体骨移植重建骨盆肿瘤切除后骨结构缺损可获满意近期疗效。Objective To investigate the short-term effectiveness of allogeneic bone transplantation for pelvic reconstruction of large skeletal defects after tumor resection. Methods Between January 2008 and November 2009, 9 patients with pelvic tumor were treated, and the clinical data were retrospectively analyzed. There were 1 male and 8 females with an average age of 36.1 years （range, 18-44 years）. There were 5 cases of giant cell tumor of bone, 2 cases of chondrosarcoma, 1 case of malignant giant cell tumor of bone, and 1 case of Ewing sarcoma. According to the Enneking system for staging musculoskeletal tumors, the lesion involved ilium （region Ⅰ） in 4 cases, acetabulum （region Ⅱ） in 6 cases, pubis and ischium （region Ⅲ） in 3 cases, and sacrum （region Ⅳ） in 1 case. The average disease duration was 6.8 months （range, 1-36 months）. After accurate resection of the tumor, allograft ilium with or without acetabulum was used in 6 cases and 2 cases respectively, and allogenous bone plate in 1 case for pelvic reconstruction; total hip arthroplasty was performed in 6 cases; sacrum screw was used in 1 case. Results Infection of incision and abdominal distention occurred in 1 case, and was cured after debridement; primary healing of incision was obtained in the other cases, without infection, lower limb deep venous thrombosis, or dislocation. The average follow-up was 11.8 months （range, 8-15 months）. The X-ray films showed breakage of plate in 1 case at 8 months after operation and partial bone resorption in 2 cases; good position of the prosthesis, plate, and transplanted bone was observed in the other cases. No local recurrence was found. At last follow-up, the average musculoskeletal tumor score （MSTS） was 23 （range, 18-29）. Conclusion Allogeneic bone transplantation for pelvic reconstruction of large skeletal defects after tumor resection can achieve satisfactory short-term surgical and functional effectiveness.

关 键 词：骨盆肿瘤 同种异体骨移植 骨盆修复重建 

分 类 号：R687.3[医药卫生—骨科学]