累及髋臼的原发良性与交界性骨肿瘤的术式选择与预后评估  

Surgical approach and prognosis evaluation of primary benign and aggressive bone tumors involving the acetabulum

作　　者：张珠晟 刘琦 鲍其远 沈宇辉[1] 张伟滨[1] 万荣[1] ZHANG Zhu-sheng;LIU Qi;BAO Qi-yuan;SHEN Yu-hui;ZHANG Wei-bin;WAN Rong(Department of Orthopaedic,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院骨科,上海200025

出　　处：《上海交通大学学报（医学版）》2021年第11期1470-1477,共8页Journal of Shanghai Jiao tong University:Medical Science

基　　金：中国临床肿瘤学科学基金(Y-HR2019-0442)。

摘　　要：目的·探讨并总结累及髋臼的良性与交界性骨肿瘤(benign and aggressive bone tumors,BABT)的一般特点、处理原则及预后因素。方法·收集88例髋臼病灶患者病例资料,其中41例为髋臼BABT,就患者人口学资料、外科治疗的选择以及患者的预后情况等进行分析。结果·41例髋臼BABT术后中位随访时间42.6个月。其中30例行病灶刮除植骨术,2例行病灶刮除骨水泥填充术,8例行瘤段切除联合骨盆假体重建术,1例行半骨盆截肢术。术后病理提示良性者23例,其中8例伴有骨皮质破损(34.8%),仅有2例复发。术后病理提示交界性者18例,其中14例伴有骨皮质破损(77.8%),共有5例复发。7例骨巨细胞瘤中1例复发(14.3%),4例非典型软骨肿瘤中3例局部复发(75.0%)。结论·髋臼良性肿瘤不伴骨皮质破损者,单纯刮除术后复发罕见。交界性肿瘤和/或伴骨皮质破损者,单纯刮除术复发率较高,需术前严格确定手术边界。其中,骨巨细胞瘤可酌情采用病灶刮除骨水泥填充术或是瘤段切除术,而非典型软骨肿瘤建议行瘤段切除联合骨盆假体重建术。Objective·To summarize the general characteristics,management principles and prognosis of benign and aggressive bone tumors(BABT) involving the acetabulum.Methods·A total of 88 cases of primary acetabular lesions were collected,including 41 cases of BABTs.The demographic data of the patients,the surgical procedures and the prognosis of the patients were analyzed.Results·The median follow-up time of the 41 cases of BABTs was 42.6 months.Lesion curettage with bone grafting was performed in 30 cases,followed by curettage with cement reconstruction(n=2),enbloc resection with endoprosthesis reconstruction(n=8),and hemi-pelvic amputation(n=1).Postoperative pathology confirmed a benign tumor in 23 cases,8 of which were accompanied by bone cortical damage(34.8%),and only 2 patients had local recurrence.Postoperative pathology demonstrated an aggressive histology in 18 cases,14 cases of which were accompanied by bone cortical damage(77.8%),and a total of 5 cases had local recurrence.Of the 7 giant cell tumors of bone,one recurred(14.3%),in comparison to 3 local recurrence(75.0%)of the 4 cases of atypical cartilage hyperplasia.Conclusion·Benign acetabular tumors without cortical bone damage have a low recurrence rate following lesion curettage.Aggressive tumors and/or tumors with cortical bone damage have a higher recurrence rate following simple curettage,and the surgical margin needs to be strictly determined prior to surgery.Specifically,lesion curettage with bone cement or enbloc resection with endoprosthesis reconstruction could be an appropriate option for giant cell tumor of bone,while enbloc resection with endoprosthesis reconstruction should be always recommended for atypical cartilage tumor.

关 键 词：髋臼 良性与交界性骨肿瘤 手术方式 预后因素 

分 类 号：R323.5[医药卫生—人体解剖和组织胚胎学] R730.262[医药卫生—基础医学]