Evaluation of different surgical techniques and treatment outcomes of pelvic metastases

背景：目前对于骨盆转移癌的治疗尚无统一的认识，是否需要进行外科干预亦存在争议。<br> 目的：回顾总结骨盆转移瘤，特别是髋臼周围转移瘤的治疗经验。<br> 方法：2000年7月至2014年7月共收治228例骨盆转移瘤患者，其中男124例，女104例；年龄20~82岁，平均（53.7±13.2）岁。163例术前有明确恶性肿瘤原发灶，23例术前活检证实转移瘤，其余42例术后病理证实为转移瘤。行髂骨翼整块切除、钉棒系统内固定重建39例，重建髋关节162例（包括骨水泥型全髋置换27例，带翼网杯全髋置换45例，斯氏针骨水泥髋臼成型全髋置换术21例，可调试半骨盆假体置换69例），单纯肿瘤局部切除18例，因肿瘤巨大及严重疼痛行半盆截肢9例。<br> 结果：所有患者均平稳度过围手术期。228例中57例失随访，171例获得随访，随访时间为6~24个月，平均（13.0±8.5）个月。术前均存在不同程度的髋部或腿部疼痛，多数负重时疼痛明显加重，术前疼痛评分4~9分，平均（7.2±2.8）分；术后均有不同程度的疼痛缓解和行走能力恢复，术后疼痛评分0~5分，平均（3.5±1.6）分。涉及髋臼周围转移癌的120例髋关节功能重建的MSTS93功能评分12~26分，平均（18.3±4.9）分；非髋臼区的51例为19~30分，平均（23.5±9.2）分。HarringtonⅢ型髋臼周围转移癌中，采用斯氏针骨水泥髋臼成型+全髋置换术的18例患者的MSTS93功能评分13~23分，平均（17.6±4.2）分；采用可调式半骨盆置换重建髋关节功能的60例患者的MSTS93功能评分12~25分，平均（18.9±3.9）分。21例（12.3%）患者出现局部复发。<br> 结论：对于骨盆转移癌导致严重疼痛和行走困难的患者，外科治疗可以缓解症状。肿瘤切除方式以病灶内手术为主，对于单发的、预后较好的骨转移病灶，可行整块切除术。对于HarringtonⅢ型髋臼转移癌患者，从功能恢复上来讲，采用斯氏针骨水泥髋臼成型术不如可调式半骨盆置换术。Background:The treatment of pelvic and sacral metastases remains diverse and has not a standard protocol. <br> Objective:The aim of the study is to retrospectively review different surgical procedures for pelvic metastases, especially for peri-acetabular metastases. <br> Methods:A total of 228 pelvic metastatic patients underwent surgical treatment between July 2000 and July 2014 in our hos-pital. There were 124 males and 104 females with an average age of (53.7±13.2) years (range, 20-82 years). There were 163 patients with primary malignant tumor, 23 with metastatic tumor confirmed by preoperative biopsy, and 46 with metastatic tumor confirmed by postoperative pathological section. The defect was reconstructed by screw-rods system in 39 patients. The acetabula were reconstructed in 162 patients including bone cement arthroplasty in 27, acetabular reinforcement with winged cup in 45, Steinmann pin with bone cement acetabuloplasty in 21 and pelvic prosthetic reconstruction in 69. Simple tumor resection was done in 18 patients. Hemipelvectomy was performed in 9 patients. <br> Results:The surgical procedure was accomplished in all the patients. But eventually, 171 patients were followed up with an average period of (13.0 ± 8.5) months (range, 6-24 months). Pain and mobility improvements were seen in all patients after operation. The average VAS pain score was 7.2±2.8 (range, 4-9) and 3.5±1.6 (range, 0-5) before and after operation, respec-tively. Function was evaluated based on MSTS93 score system. Average MSTS93 score was 18.3±4.9 (range, 12-26) in ac-etabular reconstruction patients and 23.5 ± 9.2 (range, 19-30) in the patients without acetabular invasion. In patients with HarringtonⅢacetabular metastatic lesion, two reconstruction techniques were used;the average MSTS93 score was 17.6± 4.2 (range, 13-23) in patients with Steinmann pin and bone cement acetabuloplasty and was 18.9±3.9 (range, 12-25) in pa-tients with pelvic prosthetic reconstruction. Local recurrence was found in 21 patients (12.3%). <br> Conclusions:The indication of surgical intervention for pelvic metastasis is severe pain and difficulty in ambulation caused by metastatic lesions. The surgical procedure for most metastases is intralesional surgery. Wide or marginal resection is an alternative method for solitary or good prognostic pelvic metastasis. For patients with HarringtonⅢacetabular metastatic le-sion, from the functional point of view, pelvic prosthetic reconstruction is better than Steinmann pin and bone cement ace-tabuloplasty.0149-5