改良Ganz-髂腹股沟入路联合Lars韧带行软组织重建治疗骨盆Ⅱ区肿瘤的疗效研究  

Clinical outcomes of modified Ganz-iliac inguinal approach combined with Lars ligament

作　　者：赵子仪 赵雪林 郭子轩 朱庆岩 李健雄[2] 王振[2] 王梓颖 许猛[2] ZHAO Ziyi;ZHAO Xuelin;GUO Zixuan;ZHU Qingyan;LI Jianxiong;WANG Zhen;WANG Ziying;XU Meng(Chinese PLA Medical School,Beijing 100853,China;Department of Bone Tumor,the Fourth Medical Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军医学院,北京100853 [2]解放军总医院第四医学中心骨科医学部骨肿瘤科,北京100853

出　　处：《解放军医学院学报》2024年第9期931-936,共6页Academic Journal of Chinese PLA Medical School

摘　　要：背景骨盆肿瘤切除重建术中,软组织重建的有效性尚无系统研究。目的 评估骨盆肿瘤切除术中应用改良Ganz-髂腹股沟入路联合Lars韧带与假体进行骨与软组织缺损重建的临床疗效。方法 回顾性分析解放军总医院第四医学中心2019年2月—2022年1月收治的骨盆Ⅱ区肿瘤患者资料,按照不同的手术方式分为改良Ganz—髂腹股沟入路联合Lars韧带与假体行骨盆重建术组和传统髂腹股沟入路联合假体行骨盆重建组。记录并比较两组患者围术期指标以及术后12个月时MSTS评分、Harris评分、VAS评分,影像学方法复查肿瘤复发及转移情况。结果 改良手术组中,男10例,女9例,平均年龄(38.42±19.89)岁,恶性肿瘤16例,非恶性肿瘤3例;传统手术组中,男9例,女7例,平均年龄(39.68±17.52)岁,恶性肿瘤14例,非恶性肿瘤2例。两组一般资料差异无统计学意义(P>0.05)。两组患者均按术前计划完成半骨盆假体重建,无围术期死亡病例,均实现完整切除。相较于改良组,传统组术后放置引流管时间更长[(7.57±0.80) d vs (10.06±1.08) d,P<0.001],术后引流量更多[(1 519.84±280.57) mL vs (1 711.25±266.07) mL,P=0.023],差异均有统计学意义。术后12个月两组VAS评分差异无统计学意义(P>0.05);改良组MSTS评分(23.18±1.34 vs 21.10±1.03,P=0.004)、Harris评分(68.65±7.57 vs 64.17±6.94,P=0.040)均高于传统组,差异有统计学意义。传统组2例发生伤口感染,3例深部感染,改良组无并发症发生。术后平均随访(21.51±6.92)个月,两组均无肿瘤复发。结论 对于骨盆Ⅱ区肿瘤切除,与传统髂腹股沟入路重建手术相比,改良Ganz-髂腹股沟入路联合Lars韧带可更有效地恢复患者术后功能,并发症发生率更低。Background The effectiveness of soft tissue reconstruction during pelvic tumor resection has not been systematically studied.Objective To analyze the clinical efficacy of using a modified Ganz-iliac trochanteric approach combined with Lars ligament and prosthesis for bone and soft tissue defect reconstruction in pelvic tumor resection.Methods A retrospective analysis was conducted on 35 patients with pelvic tumors in zoneⅡwho were treated at our hospital from February 2019 to January 2022.The patients were divided into two groups based on different surgical methods:one group underwent pelvic reconstruction using the modified Ganz-iliac trochanteric approach combined with Lars ligament and prosthesis,while the other group underwent traditional iliac trochanteric approach combined with prosthesis for pelvic reconstruction.Perioperative indicators,MSTS score,Harris score,VAS score at 12 months post-surgery,as well as imaging examinations to assess tumor recurrence and metastasis were recorded and compared between the two groups.Results In the modified surgery group,there were 10 males and 9 females with an average age of(38.42±19.89)years;16 cases had malignant tumors and 3 cases had benign tumors.In the traditional surgery group,there were 9 males and 7 females with an average age of(39.68±17.52)years;including 14 cases of malignant tumors and 2 cases of benign tumors.There was no statistically significant difference in general data between the two groups(P>0.05).Both groups completed hemipelvic prosthesis reconstruction according to preoperative plans,and no perioperative death occurred.Compared to the modified group,the traditional group had longer postoperative drainage time(7.57±0.80 days vs 10.06±1.08 days,P<0.001),greater postoperative drainage volume(1519.84±280.57 mL vs 1711.25±266.07 mL,P=0.023),with statistically significant difference.At 12 months after surgery,MSTS score(23.18±1.34 vs 21.10±1.03,P=0.004)and Harris score(68.65±7.57 vs 64.17±6.94,P=0.04)of the modified group were significantly

关 键 词：骨盆肿瘤 Ganz入路 Lars韧带 骨与软组织重建 

分 类 号：R738[医药卫生—肿瘤]