髋臼周围恶性肿瘤的外科治疗

目的 探讨髋臼周围恶性肿瘤保肢手术的方法和疗效.方法 回顾性分析1999年1月至2006年12月行保肢手术的31例髋臼周围恶性肿瘤患者的临床资料.其中男性17例,女性14例;年龄42～75岁,平均53岁.软骨肉瘤24例、尤文肉瘤4例、骨肉瘤1例、转移性肿瘤2例.Ⅱ区切除16例,Ⅰ+Ⅱ区切除5例,Ⅱ+Ⅲ区切除5例,Ⅰ+Ⅱ+Ⅲ区切除5例.肿瘤切除后重建17例,未重建14例.结果 31例患者随访时间12～84个月,平均52个月.14例患者无瘤生存,4例带瘤生存,13例死亡.软骨肉瘤的复发率为20.8%,死亡率33.3%.2例转移性肿瘤患者广泛转移,死于术后11和34个月.1例骨肉瘤和2例尤文肉瘤患者死于肺转移.采用Enneking骨肿瘤术后患者的功能评估方法,18例存活的患者参加功能评价.13例切除后重建的患者中优6例、良好6例、差1例.6例未重建患者优3例、良好2例、差1例.6例患者术后出现可控性并发症.结论 广泛切除肿瘤降低局部复发率是围髋臼肿瘤保肢手术的基本要求,重建髋关节的功能应综合考虑肿瘤破坏的范围和手术切除的范围,遵循个体化原则.

The surgical therapy of periacetabular malignant tumors

Objective To study the limb salvage methods and treatment outcomes in malignant periacetabular bone tumors.Methods The data of 31 patients of periacetabular malignant tumors who had limb salvage surgery between January 1999 and December 2006 was retrospectively reviewed.There were 14 females and 17 males with a mean age of 53 years (range,42-75 years).Twenty-four patients had chondrosarcomas,4 patients had Ewing sarcomas,1 patient had osteosarcoma,and the remaining 2 patients had metastatic disease.Sixteen patients had Types Ⅱ pelvic resections.5 patients had Types Ⅰ and Ⅱ pelvic resections,another 5 had Type Ⅱ and Ⅲ pelvic resections,and Type Ⅰ,Ⅱ and Ⅲ pelvic resections in the remaining patients.Seventeen patients had reconstructions after tumor resection.Results The mean follow-up time for all patients was 52 months(range,12-84 months).Fourteen patients were alive with no evidence of disease,4 patients were alive with disease at the most recent follow-up,and 13 patients died of disease.The local recurrence rate and mortality rate in 24 patients with chondrosarcomas was 20.8% and 33.3% respectively.Two patients with metastatic disease died at 11 and 34 months postoperatively.One patient with osteosarcoma and 2 patients with Ewing Sarcoma died of lung metastases.Enneking scoring system was used to evalume the functional outcome in 18 alive patients. In 13 patients who had reconstructions,6 were in excellent,6 were in good,and 1 was in poor.While in 6 patients who had no reconstructions,3 were in excellent,2 were in good,and 1 was in poor.Minor complications Occurred in 6 patients.Conclusions Clear margin tumor resection with decreased local recurrence rate is critical for limb salvage surgery in periacetabular sarcomas.The ranges of tumor invasion and resection,the principle of individual treatment should be considered in functional reconstruction.