组配式半骨盆假体置换术中髋关节旋转中心定位及临床意义

目的探讨髋臼周围肿瘤切除组配式半骨盆假体置换术中髋关节旋转中心的定位及临床意义。方法 2004年1月至2014年1月我院行骨盆肿瘤切除组配式半骨盆假体重建患者42例，以国际肌肉骨骼肿瘤协会评分（MSTS评分）评估术后功能，并分析患者术后并发症、生存率及复发率等效果。测量假体髋关节旋转中心的位置，以理想旋转中心的位置作参照，在水平方向上将其分成内移组、正常组和外移组，在纵轴方向上将其分为上移组、正常组和下移组等亚组，并分析假体髋关节旋转中心的偏移与患者术后1月、3月、6月和12月功能的关系。结果共随访分析42例患者，男性25例，女性17例。年龄12~69岁，平均年龄38岁。随访时间12~86月，平均随访36月。术后并发症发生率31.0%，髋关节脱位发生率7.1%。3年生存率69.4%、5年生存率43.7%。术后1月、3月、6月功能逐渐好转，MSTS评分呈递增趋势，3个时间点的MSTS评分比较，差异有统计学意义（P<0.05）；术后6月、12月功能改善不明显，差异无统计学意义（P>0.05）。髋关节旋转中心定位在纵轴方向及水平方向上均不影响患者术后功能（P>0.05）。结论将假体固定在最易牢固固定、软组织可充分覆盖、髋周肌肉易于重建和股骨偏心距得到一定程度恢复的位置，组配式半骨盆假体治疗骨盆肿瘤疗效满意，髋关节旋转中心的位置与术后功能的关系仍需要进一步的证据加以明确。

英文摘要:

Objective To investigatethe clinical significance of hip rotation center location after reconstruction with modular hemipelvic prostheses for periacetabula tumors. Methods Forty-two patients who received periacetabular tumor resection and reconstruction with modular hemipelvic prosthesis between January 2004 and January 2014 in our institute were included. Postoperative complications, function (measured by MSTS score), survival rate and recurrence rate were analyzed. The position of prosthetic hip rotation center was measured. By its deviation angle from the ideal rotation center, the patients were divided into inward group, normal group and outward group in the horizontal level, and upward group, normal group and downward group in the vertical direction. And the relationship between positional difference of prosthetic hip rotation center and function at 1 month, 3 months, 6 months and 12 months after surgery was analyzed. Results Of forty-two cases in total, 25 patients were male and 17 patients were female. The age of the patients ranged from 12 and 69 years (median, 38 years).The minimal followup period was 12 months (mean,36 months; range,12-86 months).The complication rate was 31.0% and hip dislocation rate was 7.1%. The overall survival rate was 69.4% at 3 years and 43.7% at 5 years. After 1 month, 3 months, 6 months, the function of the reconstructed hip gradually improved, with MSTS score showing an increasing trend. The MSTS scores at these three time points were compared, the difference was statistically significant (P<0.05). The improvement of function after 6 months and 12 months was not obvious, with the difference not being statistically significant (P> 0.05). The deviation of hip rotation center in the longitudinal direction and the horizontal direction did not affect the function of the hip (P>0.05). Conclusion It is safe and effective for patients with pelvictumorto receive modular hemipelvic prosthesis reconstruction once the prosthesis is fixed in the most firmly position, where soft tissue fully covered, the muscles could be rebuilt more easily andwhere the eccentricity of the femoral got a certain degree of recovery. The relationship between the deviation of hip rotation center and postoperative function needs to be confirmed.

查看全文查看/发表评论下载PDF阅读器

关闭