CAJ | 학술논문

目的探讨股骨头旷置术治疗髋臼周围肿瘤的可行性.方法 1999年10月至2009年8月采用髋臼肿瘤切除股骨头旷置术治疗累及髋臼的Enneking Ⅱ区肿瘤患者18例,男16例,女2例;年龄18～72岁,平均54岁.软骨肉瘤4例,骨肉瘤2例,骨巨细胞瘤4例,滑膜肉瘤1例,恶性纤维组织细胞瘤1例,Ewing肉瘤1例,转移瘤5例.3例行术前选择性动脉栓塞,4例行麻醉后腹主动脉或髂总动脉球囊临时阻断.术后门诊随访观察关节功能及影像学变化.结果全部病例随访3～118个月,平均55个月.手术时间120～350min,平均170min.出血量600～2200ml,平均1200ml.切口均愈合,无一例发生伤口感染.1例骨肉瘤、3例转移癌患者于术后6个月至2年死于多脏器转移,其余病例无肿瘤局部复发.肢体不等长2.0～7.5 cm,平均5.0 cm,所有患者均需足跟垫高2～3 cm的矫形鞋进行矫正.术后3个月Enneking评分20～27分,平均23分.影像学资料提示,至随访期末无股骨头坏死发生,8例假臼磨造较好,1例发生轻度腰椎侧凸.结论对于累及髋臼的Enneking Ⅱ区肿瘤采用肿瘤切除股骨头矿置术术后并发症发生率低,近期功能良好,肿瘤复发率低.
목적 탐토고골두광치술치료관구주위종류적가행성.방법 1999년10월지2009년8월채용관구종류절제고골두광치술치료루급관구적Enneking Ⅱ구종류환자18례,남16례,녀2례;년령18～72세,평균54세.연골육류4례,골육류2례,골거세포류4례,활막육류1례,악성섬유조직세포류1례,Ewing육류1례,전이류5례.3례행술전선택성동맥전새,4례행마취후복주동맥혹가총동맥구낭림시조단.술후문진수방관찰관절공능급영상학변화.결과 전부병례수방3～118개월,평균55개월.수술시간120～350min,평균170min.출혈량600～2200ml,평균1200ml.절구균유합,무일례발생상구감염.1례골육류、3례전이암환자우술후6개월지2년사우다장기전이,기여병례무종류국부복발.지체불등장2.0～7.5 cm,평균5.0 cm,소유환자균수족근점고2～3 cm적교형혜진행교정.술후3개월Enneking평분20～27분,평균23분.영상학자료제시,지수방기말무고골두배사발생,8례가구마조교호,1례발생경도요추측철.결론 대우루급관구적Enneking Ⅱ구종류채용종류절제고골두광치술술후병발증발생솔저,근기공능량호,종류복발솔저.
Objective To study clinical application of femoral head exclusion after resection of pelvic tumors around acetabulum with less limb damage and complications.Methods From October 1999 to August 2009,18 patients with pelvic tumors around acetabalum (zone Ⅱ of Ennekingl were treated with tumor resection and femoral head exclusion,including 16 males and 2 females with an average age of 54 years(range,18-72).The diagnosis were chondrosarcoma(4 cases),osteosarcoma(2),giant cell tumor of bone(4),synoviosareoma(1),malignant fibrous histiocytoma(1),Ewing sarcoma(1),and metastatic carcinoma(5).Throe cases were treated by selective arterial embolization before operation and 4 cases by temporary block of lower abdominal aorta or common iliac arte.Regular follow-up in clinic was done to observe function of joint and radiographic imaging.Results All patients were followed up for 55 months(range,3-118).The mean surgical time was 170 min(range,120-350 min).The mean blood loss was 1200 ml(range,600-2200 ml).All wounds were healed without infection.One patient with osteosarcoma and 3 with metastatic carcinoma died of multiple organ metastases during 6 months to 2 years after operation.The others had no local relapse.The mean limb discrepancy was 5.0 cm (range,2.0-7.5 cm).The mean Enneking score was 23 (range,20-27).All patients needed custom-made shoes with heightened heel of 2-3 cm.Osteonecrosis of the femoral head was not found in radiographic images.Eight cases had formed artificial acetabulum.One case had gentle lumbar scoliosis.Conclusion The clinical application of femoral head exclusion after resection of pelvic tumors around acetabulum had low complications,less pain,low relapse,better function in the recent period.