Clinical Analysis Of Hemi-pelvic Prosthesis Arthroplasty For Acetabular Malignant Tumors Of 6 Cases

Background:The anatomy of the pelvic is complex. The pelvic is closely related to surrounding organs, major blood vessels and nerves nearby. The malignant tumors are often prone to violations of the surrounding pelvic organs, major blood vessels and nerve tissue, leading to more difficulty in surgical resection, more complications, more postoperative recurrences, and lower survival rate. The treatment of malignant pelvic is faced by orthopedic surgeons with enormous difficulties and challenges. How to not only get complete tumor resection but also preserving limb function is the most important issue for orthopedic surgeons to resolve. Limb salvage surgery under the premise of complete tumor resection has been proved an effective surgical treatment of pelvic malignancies in recent years, and hemi-pelvic prosthesis arthroplasty is the best kind of limb salvage surgery for EnnekingⅡDistrict (acetabular) malignant tumors.Objective:To analyze the clinical results of hemi-pelvic prosthesis arthroplasty for acetabular malignant tumors of 6 cases in our hospital.Methods:A retrospective analysis of 6 cases of hemi-pelvic prosthesis arthroplasty for acetabular malignant tumors from May 2009 to January 2011 in our hospital, including 4 males and 2 females, aged from 43 to 61 years old, average 53 years. The diagnosis was chondrosarcoma in 2 cases, synovial sarcoma in 1 case, Ewing sarcoma in 1 case, metastatic carcinoma in 2 cases. According to Enneking partition,Ⅰ+ⅡDistrict in 3 cases,Ⅱ+ⅢDistrict in 3 cases. According to Enneking stage,ⅡA 3 cases,ⅡB 1 case, metastatic carcinoma in 2 cases.5 cases of intraoperative balloon occlusion of abdominal aortic blood flow,2 patients received postoperative chemotherapy. Patients recorded the length of time, blood loss, and hospital treatment of the situation, intraoperative and postoperative complications and other projects. Followed up an average of 11 months (2 to 22 months). By telephone followed up include survival of patients, walk, and squat, stand up, the need for assistive devices, whether there is pain, gait, satisfaction and so on.Results:The average operation time is 5 hours (4 hours to 5 hours and 50 minutes). The average blood loss was 5350ml (1800ml to 9000ml); which balloon occlusion of abdominal aortic blood flow in 5 patients with an average of 4620ml bleeding (1800ml～6500ml).2 patients with chemotherapy, including 1 case of synovial sarcoma, metastatic carcinoma in the other case. Complications:2 patients had periprosthetic effusion; 1 case of cervical cancer patients with bone metastases had vaginal rupture during operation and were repaired in surgery, and 10 days after operation hip prosthesis dislocation, closed reduction successes,6 months after surgery, the patient went to hospital again because of infection after chemotherapy, anti-infection control ineffective, then remove the prosthesis by surgery and the infection was controlled; 1 case appeared twice dislocation of the hip prosthesis 12 days and 15 days after surgery, were performed under fluoroscopic reduction and reduction techniques; 1 case in a dislocation of the hip prosthesis 2 months after surgery, cured by hip joint revision surgery.5 patients or their families received a follow-up, lost in 1 cases. In the follow-up of 5 cases,2 patient dyed due to tumor local recurrence and systemic metastasis.3 patients at walked out of bed 3 months after surgery, able to independently do the squat and stand up action,1 case need no instrument,2 patients required assisted cane. The 3 patients got slight hip pain during the event, while didn't need taking pain medicine. Function was well, gait was normal, and patients were satisfied with the surgery. Functional results were satisfactory.Conclusion:The hemi-pelvic prosthesis arthroplasty for acetabular malignant tumors had many complications, high short-term survival, while the 5-year survival remains to be seen, but more satisfied with the clinical effects of function, patients are likely to accept. Active prevention and treatment of surgical complications and improve the survival rate is the key to improve clinical results.