Clinical Effect Ananysis Of Hemipelvic Replacement And The Research Analysis Of Surgical Complications

Objective:Evalute the matched hemipelvic replacement surgery effect of malignant tumors of Ⅱ,Ⅲ area of pelvic and the cause and clinical treatment countermeasures of the complications relate to the operation.Methods:Retrospective analysis 21 patients with malignant pelvic tumors treated operatively between May 2003 and June 2015 in the first hospital of GUANG XI medical university. The series comprised 12 males and 9 females. Aged 30-67, average of 48.11 cases were diagnosed as chondrosarcoma,3 as osteosarcoma,1 as giant cell tumors(GCT),6 as metastases. According to Enneking’s division, all the pelvic tumor were region Ⅱ or region Ⅱ and Ⅲ, stages were IIB or above. All the 21 patients reconstructed with combinational hemipelvic prosthesis after resection of malignant pelvic tumors. To observe the quality of life and the postoperative complications by follow-up the patients.Results:21 patients were followed up for a median period of 31 months (range; 6-76 months),4 cases occurred local recurrence were treated by neoplasms local resection and radiation therapy. Infection of incision were found in 5 cases among them, repaired the wound through local debridement. Dislocation of the hip occurred in 7 patients after operation,2 cases among them cured by manual reduction, skin traction and external fixation, anther 5 cases treated by open reduction.15 of 21 patients with malignant pelvic tumors were still living,6 patients dead. No local recurrence was found and lung metastases occurred in 4 patients, who died of respiratory failure.2 of 21 patients with malignant metastases tumors had obviously alleviate in pain, no local recurrence treated with chemotherapy, but died of systemic multiple transfer in postoperative 6 months and 19 months. All the patients can reserve part of pelvic function and stability in the postoperative follow-up 3-6 months period for the first time. According to VAS pain score, an average of 3 points, Harris hip joint functional score range 30 points to 90 points, an average of 76 points, MSTS functional score range 30% to 80%, an average of 72%. The single factor analysis by Logistic showed:age, basic diseases, history of surgery, history of radiation and chemotherapy, the tumor size and the time of operation are related to the occurrence of infection after operation, infection of incision, tilt angle of pelvic, acetabular abducent angle and the acetabular anteversion angle are relate to the prosthesis dislocation after operation.Conclusions:According to tumor location and scope for malignant pelvic tumors in region II or III, To chose the proper surgery method can maximize the retention of body function. Reconstructed with combinational hemipelvic prosthesis after resection of malignant pelvic tumors can reserve and rebuilt the activity of the hip, limb pain eased significantly, which would not only hold the length of the lower limb, but also reserve the good function of pelvic. Comprehensive perioperative preparation, intraoperative strict standardization of operation, postoperative progressive function rehabilitation training and actively prevent and deal with complications are the key of successful operation.