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目的探讨髋臼周围肿瘤的切除与自体腓骨移植重建的临床疗效。方法回顾分析1999年1月至2003年4月,髋臼周围肿瘤患者行肿瘤切除和自体腓骨移植重建手术的临床资料。8例患者,男5例,女3例;年龄21～65岁,平均39.6岁。1例骨肉瘤,2例软骨肉瘤,3例转移瘤,1例巨细胞瘤,1例动脉瘤样骨囊肿。4例原发恶性肿瘤患者Enneking外科分期:ⅠB型1例,ⅡB型3例。根据Enneking等骨盆肿瘤部位分型方法,Ⅱ型5例,Ⅰ+Ⅱ型3例。根据Enneking等髋臼肿瘤切除方法,B1型切除5例,B1+A1型切除3例。8例患者中3例为吻合血管的腓骨移植。结果5例未行吻合血管腓骨移植患者骨愈合时间14～16周,平均15.2周;3例行吻合血管腓骨移植患者骨愈合时间12～15周,平均13.6周。术后5例(包括3例行吻合血管腓骨移植的患者)获得随访,随访时间14～42个月,平均28个月。患者均无瘤生存,且无全身及局部并发症。采用Enneking等术后功能评定标准,根据肢体是否疼痛、功能活动、患者满意度、承重方式、行走能力和步态六个方面进行评分,5例获随访患者评分为18～27分,平均22分,优良率为100%。结论肿瘤切除与自体腓骨移植重建是一种治疗髋臼周围肿瘤的有效方法。术后患者疼痛消除,能独立行走,有较高的满意度。
Objective To investigate the clinical effects of resection of the peri-acetabular tumor and reconstruction of autologous fibula. Methods From January 1999 to April 2003, the clinical data of patients with tumors around the acetabulum underwent resection of tumors and reconstruction of fibula were retrospectively analyzed. 8 patients, 5 males and 3 females; aged 21 to 65 years, mean 39.6 years. 1 osteosarcoma, 2 chondrosarcoma, 3 metastases, 1 giant cell tumor and 1 aneurysmal bone cyst. Enneking surgical staging was performed in 4 patients with primary malignant tumor: type ⅠB in 1 case and type ⅡB in 3 cases. According to Enneking and other pelvic tumor site typing method, Ⅱ type in 5 cases, Ⅰ + Ⅱ type in 3 cases. According to Enneking and other acetabular tumor resection methods, B1 type resection in 5 cases, B1 + A1 resection in 3 cases. Three of the eight patients were fibula-grafted for vascular anastomosis. Results The bone union time was 14 weeks to 16 weeks in 5 cases without fibula graft. The average time was 15.2 weeks. The bone union time was 12 to 15 weeks in 3 cases with anastomosis of fibula. The average time was 13.6 weeks. Five patients (including 3 patients who underwent vascular fibula transplantation) were followed up for 14-42 months (average 28 months). Patients were tumor-free survival, and no systemic and local complications. Enneking and other postoperative functional assessment criteria, according to whether the body pain, functional activity, patient satisfaction, bearing capacity, walking ability and gait six aspects of scoring, 5 patients were followed up score was 18 to 27 points, an average of 22 points , Good rate of 100%. Conclusion Tumor resection and autologous fibular graft reconstruction is an effective method for the treatment of tumors around the acetabulum. Postoperative patients to eliminate pain, can walk independently, with higher satisfaction.