盆肿瘤切除后同侧自体股骨移植重建PPT.ppt

同侧股骨移植重建骨盆肿瘤切除后骨缺损 David J Biau, MD, etc Hospital Cochin, Paris, France 骨盆肿瘤切除后重建选择： 内置假体 鞍式假体 大块异体骨 坐股融合或髂股融合 同侧股骨移植，并行全髋置换，重建骨盆环： Puget and Utheza 首次于1986年提出。 优点：提供生物学重建，没有异体骨移植相关的缺点如骨折、不融合等。 1994—2005, 13cases: 9 men, 4 women, median age 51 years (22—72), 7 right limb. Chondrosarcoma: 8, Metastasis (lung, kidney, etc): 3, Myeloma 1, Radiation-induced malignant disease 1. Materials and Methods Scoring system: Merle d’Aubigne and Postel, 1954, JBJS. Score: hip range of movement pain Walking ability 3—18 points Host bone junctions: plain anteroposterior, lateral, oblique radiograghs. Surgical technique Combined A-P surgical approach Resection of tumor Reconstruction of the pelvic defect with femoral autograft Insertion of a conventional THP Operation median time: 290 mins, 280—350 mins. Median blood transfused: 4 units, 3—8. Median stem length: 200cm, 200—250cm. Median cup diameter: 40mm, 40—48mm. Contamination of joint: 3 cases. Materials and Methods Postoperative care: Pain management, operative site care, anticoagulation. Coaptation-suspension : 2 weeks. Spica cast : 6 weeks. Weight-bearing : 2 months. Materials and Methods Results Follow-up : Median duration: 49 months (12—107 months) 7 alive and disease-free, 6 died from metastasis 5 had complications: 1 wound necrosis, 1 superficial wound infection, 1 DVT, 1 dislocation, 1 transient sciatic nerve palsy. Median score : 15 points (13.8—17 points). 7 patients walk with canes. 2 patients had 2-cm limb discrepancy, 11 patients ＜1cm. 6 patients no allograft incorporation, 5 allograft resorption. Mechanical complications : 5 patients 1: acetabular loosening with cup migration, 35 months, revision: added a metallic reinforcement ring and a 42-mm all-polyethylene cemented cup dislocation, 3.5 months, reduction. 1: fracture of graft and loosening and migration of cup, 10 months, revision: allograft and metallic reinforcement ring