The Resection And Reconstruction Of Peri-acetabular Tumor

Objective:To disscuss the diagnosis,resection of tumors,reconstruction of defects and complications of malignant tumor for acetabular and peri-acetabular region.Methods:The clinical data of 26 cases of malignant tumors of acetabular and peri-acetabular region from Feb 2002 to Agu 2009,were reviewed and analyzed Retrospectively,which were from 1st affiliated hospital of Fujian medical university. The series comprised 12 males and 14 females with a medium age of 41.45 years old(range from 10 to 68 years old). All these patient were surgically treated,of which 13 cases were chondrosarcoma,2 cases were Ewing sarcoma,4 cases were metastatic carcinoma,4 cases were malignant fibrous histiocytoma,2 cases were giant cell tumor,1 case was osteosarcoma. According to Enneking's classification,13 case with malignant bone tumor were classified at IB,6 at IIB,1 at III. 7 cases were treated by deactivation and reimplant of tumor section,1 case was treated by the replacement of artificial articulatio coxae and allograft transplantation,15 cases were treated by hemi-pelvic prosthesis after resection , 1 case was reconstructed with saddle prosthesis,2 cases with femoral head exclusion. 7 cases of primary tumor were treated by the chemotherapy,2 metastasis were received pre-operative embolization.Result:2 patients dead after operation caused by DIC and MODS. Among all the 26 cases,19 cases followed up from 6 to 76 months,30.9 months on average. 10 cases were survived,5 cases without local recurrence;7 cases diagnosed as recurrence were all chondrosarcoma,1 cases of low-grade chondrosarcoma was treated by hemi-pelvic amputation,4 cases of high-grade chondrosarcoma gave up treatment due to lung metastasis ; 2 cases of metastasis die of multiple metastases without local recurrence;1 case of malignant fibrous histiocytoma dead for lung and brain metastase without local recurrence. 2 cases received femoral head exclusion due to infection after deactivation and reimplant of tumor resection,1 case was treated by iliofemoral fusion 6 month after tihe surgery due to infection of the saddle prosthesis;skin incision problems were found in 26.9% patients(7/26),Prosthesis loosening and fracture were found in 33.3%(5/15)of which treated by hemi-pelvic prosthesis. All these been followed up can keep the pelvic stability and partly limb function.,the ISOLS'score were range from 12 to 25,19.6 on average.Conclusion:Select a proper modality for resection and reconstruction is very important;reduction wound,prophylaxis and treatment for complications actively as well as extensively resection of tumors are the key point of surgical treatment.