Analysis Of The Methods And Results Of Resection Of Primary Malignant Bone Tumors Of The Pelvis Involving The Acetabulu

Objective:To describe the surgical techniques and resection scheme design of primary malignant tumors involving the acetabulum,and to evaluate and discuss the effects of different resection schemes of primary malignant bone tumors around the acetabulum on the prognosis and postoperative function of patients.Methods:The data of 25 patients with primary malignant tumors around acetabulum who underwent tumor resection and reconstruction from January 2010 to December 2021 were collected.There were 15 males and 10 females.The average age of these patients is 39.2 years old(16 to 67 years old).Among them,14 patients were diagnosed with chondrosarcoma,7 patients with osteosarcoma,2 patients with malignant fibrous histiocytoma,1 patient with leiomyosarcoma and 1 patient with synovial sarcoma.The above patients were classified according to Enneking criteria,including 5 cases involving pelvic area Ⅱ,5 cases involving pelvic area Ⅰ+Ⅱ,13 cases involving pelvic area Ⅱ+Ⅲ,1 case involving pelvic area Ⅰ+Ⅱ+Ⅳ,and 1 case involving pelvic area Ⅰ+Ⅱ+Ⅲ+Ⅳ.No patient had distant metastasis before operation.Preoperative CT/MRI images were used to determine the surgical boundary and simulate the operation.15 patients underwent total acetabular resection and 10 patients retained part of the acetabulum.Among them,15 patients underwent total acetabular resection,and 10 patients retained part of the acetabulum.We assigned patients who underwent total acetabular resection to the total resection group and patients who retained part of the acetabulum to the partial resection group.The patients were followed up regularly after operation.The postoperative lower limb function was evaluated by MSTS scoring system,and the oncological prognosis and complications were recorded.Results:All patients obtained tumor free margins and reconstructed according to preoperative plan.The average follow-up time was 39 months.In the partial resection group,the average surgery time was 406.50 min,the average intraoperative bleeding volume was 2750ml,and 5 patients had recurrence and metastasis(accounting for 50.0%),of which 4 patients died due to extensive metastasis,including 3 cases of chondrosarcoma and 1 case of leiomyosarcoma.Among them,3 patients with chondrosarcoma died 6 months,36 months and 69 months after operation respectively.The leiomyosarcoma patient died 48 months after operation.Another case of chondrosarcoma was found to have recurrence and metastasis 68 months after operation,but this patient still survived with tumor and was in stable condition.In the total resection group,the average surgery time was 511.00 min and the average intraoperative blood loss was 3400 ml.Four patients had recurrence and metastasis(accounting for 26.7%)and died of extensive metastasis,including 3 cases of osteosarcoma and 1 case of chondrosarcoma.Three patients with osteosarcoma died 12,13 and 24 months after surgery respectively;The patient with chondrosarcoma died 58 months after operation.There was no significant difference between the two groups in postoperative infection,prosthesis disorder,recurrence,metastasis and survival rate(p>0.05).Between the two groups,there was significant difference in MSTS score(p<0.05).Conclusion:According to the results of this study,when dealing with the primary pelvic malignant tumor invading the acetabulum,as long as it can ensure a sufficient range of tumor free margin,partial acetabular resection and total acetabular resection have no significant impact on the occurrence of postoperative complications and tumor recurrence.From the perspective of functional recovery of the affected limb,accurate resection of the affected area of the acetabulum can benefit patients more than total resection of the acetabulum.