CAJ | 학술논문

目的探讨髋臼周围恶性肿瘤切除后股骨头旷置术的临床应用.方法 1997年5月至2005年6月共有25例切除后采用股骨头旷置术的髋臼周围恶性肿瘤患者得到随访,其中男性15例,女性10例;年龄16～75岁,平均42岁;骨肉瘤4例,软骨肉瘤12例,尤文肉瘤1例,原始神经外胚层瘤1例,骨髓瘤1例,恶性纤维组织细胞瘤1例,滑膜肉瘤2例,转移性肿瘤3例.根据Enneking骨盆肿瘤分区:肿瘤累及Ⅰ、Ⅱ区12例;Ⅰ、Ⅱ、Ⅲ区5例;Ⅱ、Ⅲ区4例;Ⅱ区2例;Ⅰ、Ⅱ、Ⅳ区2例.共有7例行新辅助化疗,5例行单纯术后辅助化疗,4例行术后放疗.髋臼周围切除后,采用股骨头旷置术,术后皮牵引6～8周,牵引质量2～3 kg.以后扶拐逐渐步行活动.结果 25例股骨头旷置术中6例出现手术后并发症(24.0%).随访时间3～10年,11例由于肺转移或远处转移并发肺转移死亡;2例带瘤生存;12例无瘤生存.术后5年及10年生存率分别为60%和54%.股骨头旷置术后肢体短缩在2.5～7.5 cm,平均5 cm.本组病例术后功能评价根据Enneking1993MSTS评分系统进行,平均术后功能评分是17分(12～19分).术后3个月后,患者基本能够正常坐,扶单拐跛行,能自主上下楼梯,去拐后也能跛行行走.结论累及髋臼周围的恶性肿瘤,切除后股骨头旷置术是一种可选择的重建方式,能取得相对满意的临床效果.髋臼周围高度恶性肿瘤、软组织重建条件不佳、具有感染高危倾向者、经济条件不佳的患者,是股骨头旷置术的适应证.
목적 탐토관구주위악성종류절제후고골두광치술적림상응용.방법 1997년5월지2005년6월공유25례절제후채용고골두광치술적관구주위악성종류환자득도수방,기중남성15례,녀성10례;년령16～75세,평균42세;골육류4례,연골육류12례,우문육류1례,원시신경외배층류1례,골수류1례,악성섬유조직세포류1례,활막육류2례,전이성종류3례.근거Enneking골분종류분구:종류루급Ⅰ、Ⅱ구12례;Ⅰ、Ⅱ、Ⅲ구5례;Ⅱ、Ⅲ구4례;Ⅱ구2례;Ⅰ、Ⅱ、Ⅳ구2례.공유7례행신보조화료,5례행단순술후보조화료,4례행술후방료.관구주위절제후,채용고골두광치술,술후피견인6～8주,견인질량2～3 kg.이후부괴축점보행활동.결과 25례고골두광치술중6례출현수술후병발증(24.0%).수방시간3～10년,11례유우폐전이혹원처전이병발폐전이사망;2례대류생존;12례무류생존.술후5년급10년생존솔분별위60%화54%.고골두광치술후지체단축재2.5～7.5 cm,평균5 cm.본조병례술후공능평개근거Enneking1993MSTS평분계통진행,평균술후공능평분시17분(12～19분).술후3개월후,환자기본능구정상좌,부단괴파행,능자주상하루제,거괴후야능파행행주.결론 루급관구주위적악성종류,절제후고골두광치술시일충가선택적중건방식,능취득상대만의적림상효과.관구주위고도악성종류、연조직중건조건불가、구유감염고위경향자、경제조건불가적환자,시고골두광치술적괄응증.
Objective To discuss the resection pseudoarthrosis for pelvic malignant tumors around acetabular. Methods From May 1997 to June 2005, 25 patients with malignant tumors around acetabular were treated surgically with resection pseudoarthrosis. The series comprised 15 males and 10 females with an average age of 42 years old (range from 16 to 75 years old ) . There were 4 osteosareomas, 12chondrosarcomas, 1 Ewing's sarcoma, 1 neuroectodermal tumor, 1 myeloma, 1 malignant fibrohistiocytoma,2 synovial sarcomas, and 3 metastases. Pseudoarthrosis was performed after resection of pelvic malignant tumors around acetabular. The affected side was protected postoperatively by skin traction with 2-3 kg weight for 6 to 8 weeks. After then, the patients walked gradually with a cane. Results Among 25 patients, 6 had complications(24% ). At a follow-up ranging from 3 to 10 years, 11 patients died of lung metastases, 2relapsed, 12 remained alive free of disease. There was an average crispation of 5 cm( range from 2. 5 to 7.5cm). The patients were functionally evaluated according to Enneking's MSTS criteria in 1993. The average MSTS functional score was 17 points ( 12 to 19 points). After 3 months postoperative, the patients could sit normally, walk with a cane, and even walk limpingly without cane. Conclusions Resection pseudoarthrosis for pelvic malignant tumors around acetabular results in good clinical results at the time of mid-term and long-term follow-up. And pseudoarthrosis is advisable especially for patients with malignant highly tumors around acetabular, poor soft tissue reconstruction condition, high risk for infection, poor economy.