1、同侧股骨移植重建骨盆肿瘤切除后骨缺损,David J Biau, MD, etc Hospital Cochin, Paris, France,骨盆肿瘤切除后重建选择： 内置假体 鞍式假体 大块异体骨 坐股融合或髂股融合同侧股骨移植，并行全髋置换，重建骨盆环： Puget and Utheza 首次于1986年提出。 优点：提供生物学重建，没有异体骨移植相关的缺点如骨折、不融合等。,19942005, 13cases: 9 men, 4 women, median age 51 years (2272), 7 right limb. Chondrosarcoma: 8, Metastasis
2、(lung, kidney, etc): 3, Myeloma 1, Radiation-induced malignant disease 1.,Materials and Methods,Scoring system: Merle dAubigne and Postel, 1954, JBJS. Score: hip range of movementpain Walking ability 318 points Host bone junctions: plain anteroposterior, lateral, oblique radiograghs.,Surgical techni
3、que,Combined A-P surgical approach Resection of tumor Reconstruction of the pelvic defect with femoral autograft Insertion of a conventional THP,Surgical technique,将髂腰肌肌腱自小转子处剥离，股骨近端用作自体植骨，大转子区保留，以保留臀中肌和股外侧肌止点。 股骨头与髂股相接，股骨干端与耻骨支或耻骨联合相接。牢固内固定。 在转子区重造新髋臼，并植入聚乙烯臼杯。 置入长柄水泥股骨假体，调整肢体长度，股骨内侧骨缺损区以异体骨填充，钢丝固定
4、。,Operation median time: 290 mins, 280350 mins. Median blood transfused: 4 units, 38. Median stem length: 200cm, 200250cm. Median cup diameter: 40mm, 4048mm. Contamination of joint: 3 cases.,Materials and Methods,Postoperative care: Pain management, operative site care, anticoagulation. Coaptation-s
5、uspension : 2 weeks. Spica cast : 6 weeks. Weight-bearing : 2 months.,Materials and Methods,Results,Follow-up : Median duration: 49 months (12107 months) 7 alive and disease-free, 6 died from metastasis 5 had complications: 1 wound necrosis, 1 superficial wound infection, 1 DVT, 1 dislocation, 1 tra
6、nsient sciatic nerve palsy. Median score : 15 points (13.817 points). 7 patients walk with canes. 2 patients had 2-cm limb discrepancy, 11 patients 1cm. 6 patients no allograft incorporation, 5 allograft resorption.,Mechanical complications : 5 patients 1: acetabular loosening with cup migration, 35
7、 months, revision: added a metallic reinforcement ring and a 42-mm all-polyethylene cemented cupdislocation, 3.5 months, reduction. 1: fracture of graft and loosening and migration of cup, 10 months,revision: allograft and metallic reinforcement ring and a 42-mm all-polyethylene cemented cupdislocat
8、ion, 1 months,revision: a 44-mm all-polyethylene cemented cup, stem positioned higher and a long neck (+3mm), an artificial ligament to limit the internal rotation. 1: slow migration of cup, 52 months, no revision. 2: autograft bone delayed union.,Results,Revision of reconstruction: 4 2: mechanical
9、complications, above 2: infection, underwent debridement and antibiotic therapy, resection arthroplasty.,Results,Grade-2 chondrosarcoma, 50 years.,Postoperative images.,10-months postoperative images showed cup loosening and migration.,Reconstruction with a new cemented cup and a reinforcement ring.
10、 70 months postoperatively, the autograft has united.,Cumulative rate of revision: 15%, 23%, 32% AT 1, 2, 4 years. Cumulative rate of revision for mechanical failure: 8%, 8%, 16% AT 1, 2, 4 years. 4 local recurrence.,Results,Discussion Mechanical failure: technical flaws and learning curve, inadequate fixation and insufficient support of acetabular component. Infection : 12%-26% Local recurrence: 1829%. Preoperative MRI can be helpful.,谢谢！,
