自体股骨头联合常规假体重建髋臼肿瘤切除后髋臼缺损的临床观察

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摘要目的探讨自体股骨头回植联合常规假体重建髋臼肿瘤切除后髋臼缺损的可行性，通过随访(≥2年)研究该术式的肿瘤学预后和功能预后。方法选取我院2010年4月至2017年10月收治的5例接受自体股骨头回植联合常规假体重建髋臼肿瘤切除后髋臼缺损手术的患者，术前所有患者术前完善影像学及病理学检查，以明确肿瘤性质、类型及累及髋臼的范围。随后，在计算机辅助下对肿瘤进行模拟切除，设计个性化手术方案。所有患者术后均限制负重，术后1个月使用助行器辅助行走，术后6个月独立行走。术后随访，复查骨盆CT、MRI及X线片，肺部CT检查，评价肿瘤局部控制情况。功能评分采用肌肉骨骼肿瘤学会评分(musculoskeletal tumor society，MSTS)对患肢功能进行评价。结果所有患者均顺利完成手术，术中实现了对肿瘤的R0切除，随后完成自体股骨头回植联合常规假体重建髋臼肿瘤切除后髋臼缺损，围手术期无一例死亡。术后均获得大于2年的随访，随访时间24~120个月。功能评分以末次随访的MSTS评价，5例患者末次随访功能评分为26~30分，平均为(28.2±1.6)分。随访影像学资料示：所有患者的假体均固定在位，未见髋臼假体移位、松动；未见关节脱位。所有患者均未见植骨不愈合、深部感染、术口愈合不良等并发症。结论该术式最大程度地恢复了髋臼的正常旋转中心，结合常规多孔钽金属杯及常规髋关节假体的使用，从解剖学和生物学角度实现了假体的早期和长期稳定。随访结果提示该术式是安全、有效的，并获得了良好的髋关节功能，实现了髋臼周围肿瘤术后人工关节假体的长期生存，提高了患者的生存质量。

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关键词 ：髋臼周围肿瘤, 髋臼缺损, 自体股骨头, 植骨

Abstract：Objective To explore the feasibility of the treatment of acetabular defect with autologous femoral head combined with conventional prosthesis after excision of acetabular tumor，and to study the oncologic and functional prognosis of this operation by follow-up(≥2 years).Methods Five patients admitted to our hospital from April 2010 to October 2017 who underwent the treatment of acetabular defect with autologous femoral head combined with conventional prosthesis after excision of acetabular tumor.Inpreoperative preparation，all patients underwent radiographic and pathological examination to determine the nature，type，and extent of tumor involvement in the acetabulum.Then，the simulated resection of the tumor was carried out with the help of computer，and the personalized surgical scheme was designed.Postoperatively，all patients were restricted to weight-bearing.Walking was assisted by a walking aid 1 month after the operation，and walking independently 6 months after the operation.Postoperative follow-up was conducted to review the CT，MRI and X-ray of the pelvis，and the CT of the lungs，so as to evaluate the oncologic prognosis.Musculoskeletal oncology society score(MSTS)was used to evaluate functional prognosis. Results All the 5 cases received the operation successfully，achieved R0 resection of the tumor during the operation，and reconstruction of acetabulum with autologous bone grafting combined with Porous tantalum cup and conventional hip prosthesis.All patients were followed up for more than 2 years(range，24~120 months).Functional score was evaluated by MSTS at the last follow-up，and the functional score of 5 patients at the last follow-up was 26~30 points，with an average of (28.2±1.6)points.The imaging data during the follow-up in all patients indicated that the prosthesis was fixed in all patients，no acetabular prosthesis was displaced or loosened，and no joint dislocation was observed.There were no complications such as nonunion of bone graft，deep infection and poor healing of operative mouth in all patients.Conclusion This procedure maximizes the recovery of the normal rotation center of the acetabulum.Combined with the use of conventional porous tantalum metal cups andbconventional hip prosthesis，it achieves the early and long-term stability of the prosthesis from the perspective of anatomy and biology.The results of follow-up indicated that the operation is safe and effective，and achieved good recovery of hip joint function，realized long-term survival of artificial joint prosthesis after the operation of acetabular peripheral tumor，and improved the quality of life of patients.

Key words： periacetabular tumor acetabular defect autologous femoral head bone grafting

基金资助:国家自然科学基金(81473696)
广州中医药大学第一附属医院“创新强院”工程(2019ⅡT28)

通讯作者: 易春智

作者简介: 周楠楠(1994— )，女，研究生在读，广州中医药大学第一临床医学院，510000。

引用本文:

周楠楠 1，郑嘉乾 1*，曾志明 1，蓝鋆 2，何敏聪 2，李若愚 2，方斌 2，易春智 2*. 自体股骨头联合常规假体重建髋臼肿瘤切除后髋臼缺损的临床观察[J]. 实用骨科杂志, 2021, 27(6): 492-505.
Zhou Nannan，Zheng Jiaqian *，Zeng Zhiming，et al. Observation on the Treatment of Acetabular Defect with Autologous Femoral Head Combined with Conventional Prosthesis After Excision of Acetabular Tumor. sygkzz, 2021, 27(6): 492-505.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2021/V27/I6/492

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