钽金属补块重建骨盆肿瘤切除后髋臼骨缺损的临床应用和早期疗效评价
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摘要
目的探讨累及髋臼骨盆肿瘤切除后利用钽金属补块重建髋臼骨缺损重建髋关节功能的方法可行性及早期疗效。方法 2018年1～6月,共纳入7例接受骨盆肿瘤切除钽金属补块重建髋臼骨缺损手术患者,其中男4例,女3例,平均年龄为(44.1±8.1)岁。病例类型包括软骨肉瘤4例,骨巨细胞瘤2例,骨肉瘤1例。结果 7例均顺利接受手术治疗,平均手术时间为3.5 (3～5) h;平均失血量为1200 (800～2200) ml。肿瘤部位及累及范围:根据Enneking骨盆外科分区,I+II区1例,单纯II区1例,II+III区3例,I+II+III区2例;肿瘤均获得完整切除并通过钽金属补块获得功能重建。术后均获得早期随访,随访时间6～11个月,平均8.4个月。功能评价采用MSTS-93,7例患者末次随访时功能评分为19～26分,平均24分,其中优3例,良4例。末次随访Harris髋关节评分平均为80 (60～92)分。术后并发症包括1例髋关节脱位,采用全麻下闭合复位髋关节外展支具固定后6周愈合;1例伤口表浅感染,经清创二期愈合;随访过程中,无髋臼假体发生移位及松动。结论钽金属补块可有效重建髋臼骨缺损,提供假体的早期稳定性,多孔钽金属补块利于骨长入,理论上可提高假体的长期生存率。早期随访提示钽金属补块重建骨盆肿瘤切除后的髋臼骨缺损有效,是金属半骨盆及各类生物重建方式的有效补充,并可获得良好的功能恢复。
Objective To investigate the feasibility and early effects of tantalum patch in the reconstruction of acetabular bone defects after resection of acetabular pelvic tumor. Methods From January 2018 to June 2018,7 patients underwent pelvic tumor resection and tantalum patch reconstruction for acetabular bone defects. The cohort included 4 male patients and 3 female patients with the mean age of( 44.1 ± 8.1) years. Pathology types:chondrosarcoma( n = 4), malignant bone giant cell tumor( n = 2) and osteosarcoma( n = 1). Results All surgeries went smoothly. The mean operation time was 3.5 hours( range: 3-5 hours) and the mean intraoperative blood loss was 1200 ml( range: 800-2200 ml). Location and extent of tumor involvement( Enneking Pelvic Surgical Zone):1 case in Zone I + II, 1 cases in Zone II, 3 cases in Zone II + III, and 2 cases in Zone I + II + III. All cases underwent total tumor resection and tantalum patch reconstruction. All patients were followed up for 6-11 months with an average of 8.4 months. Functional outcomes( assessed by MSTS-93): 19-26 at the last follow-up with an average of 24;3 cases were excellent and 4 cases were good. The mean Harris score was 80( range: 60-92) at the latest followup. Complications: 1 case of hip dislocation, who received closed reduction under general anesthesia and was fixed6 weeks with hip joint abduction brace; 1 case of superficial infection, who received debridement with a secondary wound healing; no prosthesis displacement or loosening happened during the follow-up. Conclusions Tantalum metal patch can effectively reconstruct acetabular bone defects and provide early stability of the prosthesis. Porous tantalum metal patch is conducive to bone ingrowth, thus improving the long-term survival rate of the prosthesis. It is an effective complement to metal half pelvic prosthesis and various biological reconstruction methods, which can achieve good functional results.
Objective To investigate the feasibility and early effects of tantalum patch in the reconstruction of acetabular bone defects after resection of acetabular pelvic tumor. Methods From January 2018 to June 2018,7 patients underwent pelvic tumor resection and tantalum patch reconstruction for acetabular bone defects. The cohort included 4 male patients and 3 female patients with the mean age of( 44.1 ± 8.1) years. Pathology types:chondrosarcoma( n = 4), malignant bone giant cell tumor( n = 2) and osteosarcoma( n = 1). Results All surgeries went smoothly. The mean operation time was 3.5 hours( range: 3-5 hours) and the mean intraoperative blood loss was 1200 ml( range: 800-2200 ml). Location and extent of tumor involvement( Enneking Pelvic Surgical Zone):1 case in Zone I + II, 1 cases in Zone II, 3 cases in Zone II + III, and 2 cases in Zone I + II + III. All cases underwent total tumor resection and tantalum patch reconstruction. All patients were followed up for 6-11 months with an average of 8.4 months. Functional outcomes( assessed by MSTS-93): 19-26 at the last follow-up with an average of 24;3 cases were excellent and 4 cases were good. The mean Harris score was 80( range: 60-92) at the latest followup. Complications: 1 case of hip dislocation, who received closed reduction under general anesthesia and was fixed6 weeks with hip joint abduction brace; 1 case of superficial infection, who received debridement with a secondary wound healing; no prosthesis displacement or loosening happened during the follow-up. Conclusions Tantalum metal patch can effectively reconstruct acetabular bone defects and provide early stability of the prosthesis. Porous tantalum metal patch is conducive to bone ingrowth, thus improving the long-term survival rate of the prosthesis. It is an effective complement to metal half pelvic prosthesis and various biological reconstruction methods, which can achieve good functional results.
引文
[1]郭卫,姬涛.髋臼周围肿瘤切除后的功能重建[J].中华骨科杂志,2015,35(2):189-194.
[2]Bus MPA,Szafranski A,Sellevold S,et al.LUMiC?endoprosthetic reconstruction after periacetabular tumor resection:short-term results[J].Clin Orthop Relat Res,2017,475(3):686-695.
[3]郭征,王臻,李靖,等.骨盆II区恶性肿瘤外科治疗建议[J].中华骨与关节外科杂志,2011,4(1):40-44.
[4]Kadhim M,Womer RB,Domans JP.Surgical treatment of pelvic sarcoma in children:outcomes for twenty six patients[J].Int Orthop,2017,41(10):2149-2159.
[5]程亮亮,赵德伟,杨磊,等.3D打印多孔钽金属髋臼加强块在成人DDH髋关节重建术中的应用[J].中华骨科杂志,2018,38(11):650-657.
[6]Migaud H,Common H,Girard J,et al.Acetabular reconstruction using porous metallic material in complex revision total hip arthroplasty:A systematic review[J].Orthop Traumatol Surg Res,2019,105(1S):S53-61.
[7]Issack PS.Use of porous tantalum for acetabular reconstruction in revision hip arthroplasty[J].J Bone Joint Surg Am,2013,95(21):1981-1987.
[8]许宋锋,刘江,聂鑫,等.酒精灭活瘤段骨在重建恶性骨肿瘤骨缺损中的应用[J].中国骨与关节杂志,2015,4(5):354-360.
[9]Healey JH.Editorial Comment:2014 Musculoskeletal tumor society[J].Clin Orthop Relat Res,2016,474(3):640-642.
[10]Martine M,Lopez S,Beebe K.Gender comparison of scholarly production in the musculo-skeletal tumor society using the hirsch index[J].J Surg Educ,2015,72(6):1172-1178.
[11]Schollner D,Ruck W.Proceedings:Pelvic prosthesis--an alternative to hemipelve-ctomy in tumor patients[J].Z Orthop Ihre Grenzgeb,1974,112(4):968-970.
[12]Dominkus M,Darwish E,Funovics P.Reconstruction of the pelvis after resection of malignant bone tumours in children and adolescents[J].Recent Results Cancer Res,2009,179(179):85-111.
[13]Anract P,Biau D,Babinet A,et al.Pelvic reconstructions after bone tumor resection[J].Bull Cancer,2014,101(2):184-194.
[14]Khan FA,Rose PS,Yanagisawa M,et al.Surgical technique:porous tantalum reconstruction for destructive nonprimary periacetabular tumors[J].Clin Orthop Relat Res,2012,470(2):594-601.
[15]Malhotra R,Kancherla R,Kumar V,et al.Trabecular metal acetabular revision system(cup-cage construct)to address the massive acetabular defects in revision arthroplasty[J].Indian JOrthop,2012,46(4):483-486.
[16]Fernandez-Fairen M,Murtia A,Blanco A,et al.Revision of failed total hip arthroplasty acetabular cups to porous tantalum components:a 5-year follow-up study[J].J Arthroplasty,2010,25(6):865-872.
[17]Joglekar SB,Rose PS,Lewallen DG,et al.Tantalum acetabular cups provide secure fixation in THA after pelvic irradiation at minimum 5-year followup[J].Clin Orthop Relat Res,2012,470(11):3041-3047.
[18]Mohandas G,Oskolkov N,Mcmahon MT,et al.Porous tantalum and tantalum oxide nanoparticles for regenerative medicine[J].Acta Neurobiol Exp,2014,74(2):188-196.
[19]Mas-Moruno C,Garrido B,Rodriguez D,et al.Biofunctionalization strategies on tantalum-based materials for osseointegrative applications[J].J Mater Sci Mater Med,2015,26(2):109.
[20]Ryu JJ,Park K,Kim HS,et al.Effects of anodized titanium with arg-gly-asp(RGD)peptide immobilized via chemical grafting or physical adsorption on bone cell adhesion and differentiation[J].Int J Oral Maxillofac Implants,2013,28(4):963-972.
[21]Miyauchi T,Yamada M,Yamamoto A,et al.The enhanced characteristics of osteoblast adhesion to photofunctionalized nanoscale TiO 2 layers on biomaterials surfaces[J].Biomaterials,2010,31(14):3827-3839.
[22]Liu Y,Bao C,Wismeijer D,et al.The physicochemical/biological properties of porous tantalum and the potential surface modification techniques to improve its clinical application in dental implantology[J].Mater Sci Eng C Mater Biol Appl,2015,49:323-329.
[23]Abdel MP,Von Roth P,Perry KI,et al.Early results of acetabular reconstruction after wide periacetabular oncologic resection[J].J Bone Joint Surg Am,2017,99(3):e9.
[24]Sun W,Li J,Li Q,et al.Clinical effectiveness of hemipelvic reconstruction using computer-aided custom-made prostheses after resection of malignant pelvic tumors[J].J Arthroplasty,2011,26(8):1508-1513.
[25]Clayer M.The survivorship of protrusio cages for metastatic disease involving the acetabulum[J].Clin Orthop Relat Res,2010,468(11):2980-2984.
[2]Bus MPA,Szafranski A,Sellevold S,et al.LUMiC?endoprosthetic reconstruction after periacetabular tumor resection:short-term results[J].Clin Orthop Relat Res,2017,475(3):686-695.
[3]郭征,王臻,李靖,等.骨盆II区恶性肿瘤外科治疗建议[J].中华骨与关节外科杂志,2011,4(1):40-44.
[4]Kadhim M,Womer RB,Domans JP.Surgical treatment of pelvic sarcoma in children:outcomes for twenty six patients[J].Int Orthop,2017,41(10):2149-2159.
[5]程亮亮,赵德伟,杨磊,等.3D打印多孔钽金属髋臼加强块在成人DDH髋关节重建术中的应用[J].中华骨科杂志,2018,38(11):650-657.
[6]Migaud H,Common H,Girard J,et al.Acetabular reconstruction using porous metallic material in complex revision total hip arthroplasty:A systematic review[J].Orthop Traumatol Surg Res,2019,105(1S):S53-61.
[7]Issack PS.Use of porous tantalum for acetabular reconstruction in revision hip arthroplasty[J].J Bone Joint Surg Am,2013,95(21):1981-1987.
[8]许宋锋,刘江,聂鑫,等.酒精灭活瘤段骨在重建恶性骨肿瘤骨缺损中的应用[J].中国骨与关节杂志,2015,4(5):354-360.
[9]Healey JH.Editorial Comment:2014 Musculoskeletal tumor society[J].Clin Orthop Relat Res,2016,474(3):640-642.
[10]Martine M,Lopez S,Beebe K.Gender comparison of scholarly production in the musculo-skeletal tumor society using the hirsch index[J].J Surg Educ,2015,72(6):1172-1178.
[11]Schollner D,Ruck W.Proceedings:Pelvic prosthesis--an alternative to hemipelve-ctomy in tumor patients[J].Z Orthop Ihre Grenzgeb,1974,112(4):968-970.
[12]Dominkus M,Darwish E,Funovics P.Reconstruction of the pelvis after resection of malignant bone tumours in children and adolescents[J].Recent Results Cancer Res,2009,179(179):85-111.
[13]Anract P,Biau D,Babinet A,et al.Pelvic reconstructions after bone tumor resection[J].Bull Cancer,2014,101(2):184-194.
[14]Khan FA,Rose PS,Yanagisawa M,et al.Surgical technique:porous tantalum reconstruction for destructive nonprimary periacetabular tumors[J].Clin Orthop Relat Res,2012,470(2):594-601.
[15]Malhotra R,Kancherla R,Kumar V,et al.Trabecular metal acetabular revision system(cup-cage construct)to address the massive acetabular defects in revision arthroplasty[J].Indian JOrthop,2012,46(4):483-486.
[16]Fernandez-Fairen M,Murtia A,Blanco A,et al.Revision of failed total hip arthroplasty acetabular cups to porous tantalum components:a 5-year follow-up study[J].J Arthroplasty,2010,25(6):865-872.
[17]Joglekar SB,Rose PS,Lewallen DG,et al.Tantalum acetabular cups provide secure fixation in THA after pelvic irradiation at minimum 5-year followup[J].Clin Orthop Relat Res,2012,470(11):3041-3047.
[18]Mohandas G,Oskolkov N,Mcmahon MT,et al.Porous tantalum and tantalum oxide nanoparticles for regenerative medicine[J].Acta Neurobiol Exp,2014,74(2):188-196.
[19]Mas-Moruno C,Garrido B,Rodriguez D,et al.Biofunctionalization strategies on tantalum-based materials for osseointegrative applications[J].J Mater Sci Mater Med,2015,26(2):109.
[20]Ryu JJ,Park K,Kim HS,et al.Effects of anodized titanium with arg-gly-asp(RGD)peptide immobilized via chemical grafting or physical adsorption on bone cell adhesion and differentiation[J].Int J Oral Maxillofac Implants,2013,28(4):963-972.
[21]Miyauchi T,Yamada M,Yamamoto A,et al.The enhanced characteristics of osteoblast adhesion to photofunctionalized nanoscale TiO 2 layers on biomaterials surfaces[J].Biomaterials,2010,31(14):3827-3839.
[22]Liu Y,Bao C,Wismeijer D,et al.The physicochemical/biological properties of porous tantalum and the potential surface modification techniques to improve its clinical application in dental implantology[J].Mater Sci Eng C Mater Biol Appl,2015,49:323-329.
[23]Abdel MP,Von Roth P,Perry KI,et al.Early results of acetabular reconstruction after wide periacetabular oncologic resection[J].J Bone Joint Surg Am,2017,99(3):e9.
[24]Sun W,Li J,Li Q,et al.Clinical effectiveness of hemipelvic reconstruction using computer-aided custom-made prostheses after resection of malignant pelvic tumors[J].J Arthroplasty,2011,26(8):1508-1513.
[25]Clayer M.The survivorship of protrusio cages for metastatic disease involving the acetabulum[J].Clin Orthop Relat Res,2010,468(11):2980-2984.