外科精确切除和全髋关节置换治疗累及髋臼前/后柱骨肿瘤的临床研究  

Clinical study of surgical precise resection and total hip replacement in the treatment of bone tumors involving anterior/posterior acetabular column

作　　者：杨勇昆[1] 徐海荣[1] 李远[1] 鱼锋[1] 牛晓辉[1] YANG Yong-kun;XU Hai-rong;LI Yuan;YU Feng;NIU Xiao-hui(Department of Orthopedic Oncology Surgery,Bejing Jishuitan Hospital,Beijing,100035,China)

机构地区：[1]北京积水潭医院骨肿瘤科,100035

出　　处：《中国骨与关节杂志》2022年第8期590-596,共7页Chinese Journal of Bone and Joint

基　　金：北京市医管局“青苗”计划(QML20200403);北京积水潭医院高层次人才“学科骨干”培养计划(XKGG202108);北京积水潭医院自然基金培育计划(ZR-202104)。

摘　　要：目的 对于累及髋臼前柱或后柱的原发恶性和侵袭性肿瘤,手术切除和重建较困难,术后并发症较多且功能损失较大。本研究的目的是通过计算机导航辅助技术实现髋臼肿瘤精确切除和全髋关节置换重建,评价肿瘤学安全性和重建方式的可靠性。方法 对2012年至2019年在我科接受计算机导航辅助手术治疗的31例髋臼原发恶性和侵袭性肿瘤进行研究。病种包括原发恶性肿瘤21例和骨巨细胞瘤10例。病灶累及前柱20例,累及后柱11例。全部病例均行肿瘤整块切除,应用自体同侧股骨头填补前/后柱缺损,并行全髋关节置换。结果 术后随访13~118个月(中位48),平均53.2个月。外科边界包括广泛12例和边缘19例,无囊内边界。患者5年总生存率95.2%。局部复发1例。非广泛和广泛边界的复发率分别为5.3%和为0。患者5年和10年无复发生存率为95.2%和81.6%。共2例假体失效,包括1例深部感染和1例肿瘤复发。5年和10年假体总存留率分别为95.2%和79.4%。伤口感染3例。MSTS功能评分17~30分,平均25.7分。结论 对于累及髋臼前柱或后柱的原发恶性和侵袭性肿瘤,通过精确切除获得的外科边界是控制局部复发的关键。计算机导航辅助技术可以辅助髋臼单柱的精确切除和结构重建,术后复发率低,功能满意且并发症较少。Objective For the primary malignant and invasive tumors involving the anterior or posterior column of the acetabulum,surgical resection and reconstruction are difficult with more postoperative complications and functional loss.The purpose of this study is to achieve accurate resection of acetabular tumors and total hip arthroplasty through computer-aided navigation,and to evaluate the safety and the reliability.Methods Thirty-one cases with primary malignant and invasive acetabular tumor,treated by navigation-assisted surgery in our department from 2012 to 2019,were studied.There were 21 cases of primary malignant tumor and 10 cases of giant cell tumor of bone.The lesions involved the anterior column in 20 cases and the posterior column in 11 cases.All cases underwent en-bloc resection of the tumor.The anterior / posterior column defect was filled with autologous ipsilateral femoral head,and total hip arthroplasty was performed.Results The average follow-up was 53.2 months (median 48,13-118 months).The surgical margin was wide in 12 cases and marginal in 19 cases,without intracapsular margin.The 5-year overall survival rate was 95.2%.Local recurrence occurred in 1 case.The recurrence rate of non-wide margin and wide margin were 5.3% and 0,respectively.The 5-year and 10-year recurrence free survival rates were 95.2% and 81.6%,respectively.There were 2 cases of prosthesis failure,including 1 case of deep infection and 1 case of tumor recurrence.The 5-year and 10-year overall survival rates of prosthesis were 95.2% and 79.4%,respectively.Wound infection occurred in 3 cases.The mean MSTS functional score was 25.7 (range:17-30).Conclusions For primary malignant and invasive tumors involving anterior or posterior column of the acetabulum,the surgical margin obtained by accurate resection is the key to control local recurrence.Computer-aided navigation will achieve precise resection and structural reconstruction of the single acetabular column.The postoperative recurrence rate is low with satisfactory function and less

关 键 词：外科手术 计算机辅助 髋臼成形术 骨肿瘤 

分 类 号：R738.1[医药卫生—肿瘤] R687.4[医药卫生—临床医学]