CAJ | 학술논문

目的：髋臼肿瘤发病率较低，由于肿瘤部位特殊，临床治疗有相当大的难度。文中探讨髋臼部位肿瘤患者的手术操作方法、疗效与并发症。方法回顾性分析南京军区南京总医院骨科2005年10月至2013年10月收治的36例髋臼肿瘤患者的临床资料，其中男21例，女15例，年龄15～64岁，平均（45．2±6．3）岁。良性肿瘤8例，占22％，其中单纯性囊肿4例，韧带样纤维瘤1例，纤维结构不良1例，血管瘤2例。恶性肿瘤28例，占78％，其中骨肉瘤5例，软骨肉瘤12例，脊索瘤1例，骨巨细胞瘤2例，恶性软骨母细胞瘤1例，恶性纤维组织细胞瘤2例，转移性肿瘤5例。良性肿瘤患者行单纯肿瘤切除＋植骨＋钢板内固定术，恶性肿瘤患者行脊柱钉棒系统联合骨水泥重建术。结果围手术期间无死亡病例，术后5例患者出现可控性并发症。术后随访时间5～96个月，1例良性肿瘤患者失访，其余患者均获随访。7例良性肿瘤患者均无复发，髋关节活动正常；恶性肿瘤患者中骨肉瘤4例、软骨肉瘤6例出现肺部转移，均死于呼吸功能衰竭，其余无瘤生存；恶性纤维组织细胞瘤1例死于术后2年，1例带瘤生存；截至末次随访日骨巨细胞瘤、恶性软骨母细胞瘤及脊索瘤患者未见局部复发或肺部转移；转移性肿瘤5例均死于术后3年内。术后3个月，患者肢体功能评价参照人工髋关节置换术后Harris评分，良性肿瘤患者7例＞90分，恶性肿瘤患者9例70～79分，19例＜70分。结论恶性肿瘤患者采用脊柱钉棒系统联合骨水泥重建术，能满足一般日常活动；手术前髂内动脉栓塞可明确减少出血和提高手术安全性；术后应尽量减少并发症的发生。
목적：관구종류발병솔교저，유우종류부위특수，림상치료유상당대적난도。문중탐토관구부위종류환자적수술조작방법、료효여병발증。방법회고성분석남경군구남경총의원골과2005년10월지2013년10월수치적36례관구종류환자적림상자료，기중남21례，녀15례，년령15～64세，평균（45．2±6．3）세。량성종류8례，점22％，기중단순성낭종4례，인대양섬유류1례，섬유결구불량1례，혈관류2례。악성종류28례，점78％，기중골육류5례，연골육류12례，척색류1례，골거세포류2례，악성연골모세포류1례，악성섬유조직세포류2례，전이성종류5례。량성종류환자행단순종류절제＋식골＋강판내고정술，악성종류환자행척주정봉계통연합골수니중건술。결과위수술기간무사망병례，술후5례환자출현가공성병발증。술후수방시간5～96개월，1례량성종류환자실방，기여환자균획수방。7례량성종류환자균무복발，관관절활동정상；악성종류환자중골육류4례、연골육류6례출현폐부전이，균사우호흡공능쇠갈，기여무류생존；악성섬유조직세포류1례사우술후2년，1례대류생존；절지말차수방일골거세포류、악성연골모세포류급척색류환자미견국부복발혹폐부전이；전이성종류5례균사우술후3년내。술후3개월，환자지체공능평개삼조인공관관절치환술후Harris평분，량성종류환자7례＞90분，악성종류환자9례70～79분，19례＜70분。결론악성종류환자채용척주정봉계통연합골수니중건술，능만족일반일상활동；수술전가내동맥전새가명학감소출혈화제고수술안전성；술후응진량감소병발증적발생。
Objective The periacetabular tumor has a low rate of incidence, but its special location poses a challenge to clinical treatment.The aim of this study was to discuss the methods, effects, and complications of surgical treatment of periacetabular tumors. Methods We retrospectively analyzed the clinical data of 36 cases of periacetabular tumor surgically treated in our depart-ment, including 21 males and 15 females, aged 15 to 64 (45.2 ±6.3) years.Among them, there were 8 cases of benign tumor (4 ca-ses of simple bone cyst, 1 case of desmoplastic fibromas, 1 case of osteofibrous dysplasia, and 2 cases of hemangioma) and 28 cases of malignant tumor (5 cases of osteosarcomas, 12 cases of chondrosarcomas, 2 cases of giant cell tumor of the bone, 1 case of malignant chondroblastoma, 2 cases of malignant fibrohistiocytoma, and 5 cases of metastatic tumor of the bone).The benign cases received sim-ple tumor resection plus bone graft and steel plate system internal fixation, while malignant cases underwent reconstruction by combined pedicle screw fixation system with bone cement. Results No patients died perioperatively and controllable complications occurred in 5 cases after operation.All the patients were followed up for 5 to 96 months except for 1 case of benign tumor.None of the benign cases experienced recurrence, and all of them achieved normal hip function.Lung metastases occurred in 10 malignant cases (4 cases of os-teosarcomas and 6 cases of chondrosarcomas) , who died of respiratory failure, and the other 18 remained tumor-free after surgery.Of the 2 patients with malignant fibrohistiocytoma, 1 died 2 years postoperatively and the other survived with tumor.Neither local recur-rence nor lung metastasis was found in the patients with chordoma and malignant chondroblastoma till the end of follow-up.The 5 pa-tients with metastases died within 3 years after operation.At 3 months after surgery, the Harris scores after total hip replacement were >90 in the 7 benign cases, 70-79 in 9 malignant cases, and <70 in the other 19 malignant cases. Conclusion For the treatment of malig-nant tumors, reconstruction by combined pedicle screw fixation system with bone cement does not affect the general daily activities of the pa-tients.Preoperative embolization of the internal iliac artery can reduce bleeding and improve operation safety, and measures should be taken to minimize postoperative complications.