摘要目的 探讨骨盆Ⅰ～Ⅲ区恶性骨肿瘤切除与功能重建的效果.方法 回顾性分析2010年1月至2018年12月山西医科大学第二医院收治的23例行保肢手术的骨盆恶性骨肿瘤患者,其中男性12例,女性11例;年龄19～78岁;原发肿瘤22例,转移瘤1例;单纯Ⅰ区13例,单纯Ⅱ区2例,单纯Ⅲ区5例,Ⅱ区+Ⅲ区1例,Ⅰ区+Ⅱ区2例.手术方法包括切除+同种异体骨移植术、切除+椎弓根钉重建术、切除+取同侧髂骨移植重建术、人工半骨盆置换术.分析患者并发症、转归、生存及功能恢复等情况.结果 23例患者均未出现围术期死亡.5例肿瘤侵袭Ⅱ区的患者行半骨盆置换术,术后未见严重并发症;15例行肿瘤切除后同种异体骨移植或自体骨移植,其中2例出现症状较轻的伤口感染,余未见较严重并发症;3例行肿瘤切除后椎弓根钉固定,术后未出现明显的并发症.至随访结束,12例患者因术后出现局部复发或肺转移而死亡,其中包括4例行半骨盆置换术的患者.23例患者步态均有不同程度改变,多数为跛行;1例患者需要扶双拐行走.结论 骨盆Ⅰ区和Ⅲ区恶性骨肿瘤在做到安全边界下广泛切除后行生物重建可获得较满意的术后疗效;骨盆Ⅱ区恶性骨肿瘤做到在安全边界下切除后选择较稳定的半骨盆假体来进行功能重建的术后疗效在可接受范围内.

abstractsObjective To discuss the efficacy of pelvic region Ⅰ-Ⅲ malignant bone tumor resection and function reconstruction. Methods A retrospective study was performed on 23 patients with pelvic malignant bone tumors who underwent limb salvage surgery in the Second Hospital of Shanxi Medical University from January 2010 to December 2018, including 12 males and 11 females, aged 19-78 years old. There were 22 cases of primary tumors, and 1 case of metastatic carcinoma. The tumor of 13 cases located in region Ⅰ, 2 cases in region Ⅱ, 5 cases in region Ⅲ, 1 case in region Ⅱ+Ⅲ, and 2 cases in region Ⅰ+Ⅱ. The surgical methods included resection + allograft, resection + pedicle screw reconstruction, resection +ipsilateral iliac bone graft reconstruction, and artificial hemipelvic replacement. The complications, outcomes, survival, and function recovery of patients were analyzed. Results None of the 23 patients died in the perioperative period. Five patients with tumor invasion region Ⅱunderwent hemipelvic replacement, and no serious complications occurred after operation; 15 patients underwent allogeneic bone graft or autologous bone graft after tumor resection , 2 of them had milder wound infection , and no serious complications were found in the others; 3 cases underwent pedicle screw reconstruction after tumor resection, and no obvious complications occurred after operation. By the end of follow-up, 12 patients died of local recurrence or lung metastases after surgery, including 4 patients who underwent hemipelvic replacement. The gait of 23 patients was changed to some extent, most of them were claudication; One patient needed to walk with two crutches. Conclusions The malignant bone tumors in the pelvic region Ⅰ and Ⅲ can achieve satisfactory postoperative results after extensive resection in the boundary of security. For pelvic region Ⅱmalignant bone tumors, the postoperative curative effect of half pelvic prosthesis reconstruction after resection in the boundary of security is acceptable.