累及骨盆Ⅱ区肿瘤切除重建术后脱位的临床特征及预防  

Clinical features and prevention of dislocation after resection and reconstruction of tumors involving pelvic area II

作　　者：曲昊 牟皓晨 王柯懿 王聪 李恒元[1] 李秀茅 林鹏[1] 李冰皓[1] 王盛东[1] 王战[1] 柳萌[1] 严晓波[1] 黄鑫[1] 林秾[1] 叶招明[1] Qu Hao;Mou Haochen;Wang Keyi;Wang Cong;Li Hengyuan;Li Xiumao;Lin Peng;Li Binghao;Wang Shengdong;Wang Zhan;Liu Meng;Yan Xiaobo;Huang Xin;Lin Yong;Ye Zhaoming(Department of Orthopedics,Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院骨科,杭州310009

出　　处：《中华骨科杂志》2022年第8期500-508,共9页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(82101649)。

摘　　要：目的探索累及骨盆Ⅱ区肿瘤切除重建术后脱位方向、脱位时间等临床特征,并尝试提出术中及术后预防措施。方法回顾并分析2011年3月至2021年3月122例累及骨盆Ⅱ区切除重建术患者,骨盆Ⅱ区32例,骨盆Ⅰ+Ⅱ区31例,骨盆Ⅱ+Ⅲ区40例,骨盆Ⅰ+Ⅱ+Ⅲ区19例;122例中发生术后脱位17例。男73例,女49例;年龄平均为47岁(范围9~73岁)。统计肿瘤学情况,手术及辅助治疗方式,术后影像学特征,脱位患者的脱位方向、脱位时间,复位方法及国际骨肿瘤协会(Musculoskeletal Tumor Society,MSTS)评分,结合切除重建术后影像学特点,分析可行的预防脱位方法。结果122例患者中共有脱位17例,脱位率13.7%,其中前脱位12例(70.6%),后脱位5例(29.4%),差异有统计学意义(χ^(2)=4.52,P=0.033)。术后3个月内发生脱位共有12例(70.6%);1例脱位发生在术后5个月,另4例脱位时间>术后1年。脱位患者复位后MSTS评分为56.1%±15.6%(20%~80%)。结合术后影像学检查,提出可行的预防脱位方法包括:可适当减小髋臼杯前倾角(0°~10°);适当将髋臼杯向旋转中心后方移位少许,适当减少股骨颈假体前倾角,三者结合可减少股骨-髋臼假体撞击的发生;同时术后患肢用严格的钉子鞋控制患肢在中立位,避免外旋的发生。结论骨盆Ⅱ区肿瘤切除重建术后脱位多以前脱位为主,股骨柄假体颈部与髋臼下缘空间较小,容易发生撞击;若适当减小髋臼杯前倾角、髋臼假体适当向后方移位及股骨颈前倾角减少5°,可减少股骨-髋臼撞击可能性,继而减少术后脱位风险。Objective To explore the clinical characteristics of dislocation after resection and reconstruction of tumors involving pelvic area II,and to try to propose intraoperative and postoperative techniques to prevent its occurrence.Methods From March 2011 to March 2021,122 patients with resection and reconstruction involving pelvic area II were retrospectively analyzed.Among them,17 had postoperative dislocation,32 had pelvic area II,and 31 had pelvic area I+II.There were 40 cases in the pelvic area II+III,and 19 cases in the pelvic area I+II+III.There were 49 female patients and 73 male patients;the mean age was 47 years(9-73 years).The Musculoskeletal Tumor Society(MSTS)score of lower extremity patients after reduction was evaluated,and the clinical characteristics of dislocation,such as dislocation direction,dislocation time and reduction method,were counted and analyzed,and feasible prevention measures were analyzed based on the imaging characteristics after resection and reconstruction.dislocation method.Results Among the 122 patients,there were 17 cases of dislocation,and the dislocation rate was 13.7%.Among them,12 cases were anterior dislocation,accounting for 70.6%of anterior dislocation;5 cases were posterior dislocation,and the proportion of posterior dislocation was 29.4%,difference(χ^(2)=4.52,P=0.033).There were 12 cases of dislocation within 3 months after operation,accounting for 70.6%;1 case of dislocation occurred in 5 months after operation,and the other 4 cases of dislocation occurred for more than one year.The MSTS score of the dislocation patients after reduction was 56.1±15.6%(20%-80%).Combined with postoperative imaging examinations,the feasible methods for preventing dislocation include:The anteversion angle of the acetabular cup can be appropriately reduced(0°-10°);The acetabular cup can be appropriately shifted to the rear of the rotation center;Appropriately reducing the anteversion angle of the femoral neck prosthesis,the combination of the three can reduce the occurrence of femoral-ace

关 键 词：骨盆 骨肿瘤 内固定器 脱位 

分 类 号：R738.1[医药卫生—肿瘤]