The Clinic Study: Reconstruction And Resection Of Periacetabular Malignant Tumor

Objective: Pelvis is an important part of the human body. Pelvic ring tumor is deep in the human body, when it was found it was large. Tumor in this region is often bulky, transgression and a broader scope of comparison the incidence of occult, found in many advanced tumors, and it brings the patient with enormous harm of physics and psychology. The tumor has a complex anatomical structure with a lot of vital organs surrounded. At the same time, the operations to the pelvic tumor is very difficult, which need Technology high,and many postoperative complications occur after the operations. If the stability is affected after the operation, we need adopt a measure to rebuild, in order to recover the stability of the pelvis. Allotted type method according to Enneking, according to the anatomic site where the tumor was grown, we divide the pelvis into 4 areas: Ilium is zone I; Acetabulum is zone II; Ischium and pubis is zone III; Ala sacralis is zone IV. The reconstruction and resection of Zone I and zone III is easier than zone II. This article will explore the pelvic tumor's resection, reconstruction and complications through the observion of our hospital's treatment of pelvic tumors.Methods: The retrospect analyses January, 2003 till September, 2009, twelve patients were diagnosed with tumor of pelvis.There five male and seven female.Six patients have received the therapy that resection of pelvic tumor and artifical prosthetic replacement; the other patients have received the therapy that resection of pelvic, have not received artifical prosthetic replacement. And all were followed up for 11-48 months through clinic return visit. Twelve patients with an average age of 44.6 year old(18-63 year old ) ,including six males and six females. Of which four cases are osteosarcoma, two case s are chondrosarcoma, two cases are Ewing sarcoma, two cases are metastatic tumor, one case is Plasma-Cell myeloma, one case is non Hodgkin B-lymphoma. Allotted type method according to Enneking pelvis tumor location: The tumors involved the zones I and according to Enneking classification in six patients, the zones II and III in there patients, the zones I,II and III in two patients, the zones II in one patient. The periacetabular tumor blood-supply arterial was embolismed for all patients, Six patients have received the therapy that resection of pelvic tumor and artifical prosthetic replacement; the other patients have received the therapy that resection of pelvic,have not received artifical prosthetic replacement. We observe the pelvic healing, the length of the leg, quality of life and related complications through the postoperative follow-up of patients.Results: All these operations were completed successfully. Six patients have received the therapy that resection of pelvic,have not received artifical prosthetic replacement. Time spent on those operations was ranged from 3-4hours, 3.6hours in average. Blood transfusion during operation was ranged from 1200-1600ml, 1450 in average. The other patients have received the therapy that resection of pelvic tumour and artifical prosthetic replacement. Time spent in those operations was ranged from 5.3-7.5hours, 6.6hours in average. Blood transfusion during operation was ranged from 2700-5200ml, 3750 in average. 12 patients were followed up for 11-80 months through clinic return visit. The patients who have not received artifical prosthetic replacement, the crispation of legs were ranged from 4.0-7.0cm, 5.3cm in average. They can wake by stick after three months. Then they can throw the stick gradually. Six patients have received the therapy that resection of pelvic tumour and artifical prosthetic replacement. They start to do functional exercise after three months. They can walk by stick between 2-3months. Then they can throw the stick gradually. At the final follow up, the average functional score was 19.5(patients have received the therapy that resection of pelvic,have not received artifical prosthetic replaceme- nt )and24.5(patients have received the therapy that resection of pelvic tumour and artifical prosthetic replacement) according to the ISOLS(International Society of Limb Salvage) postoperative functional evaluation standards, what is whether the physical pain, psychological accept, need to be supported, function, scope of activities, locomotion and gait, carried out score.Conclusions:1. In those operations, the patients have not received artifical prosthetic replacement. The time of the operation is short, hemorrhage during operation is little, patient's economic burden is slight, which are all advantages of this operation. Patients'postoperative pain was disappeared. They can walk independently without pain. This methods also can reduce the morbidity rate,and could be achieved with a high level of patient satisfaction at the stability of the limbs and the ability of weight-bearing.2. There would be early to reach firm fixed for adjustable artificial replacement for the treatment of pelvic tumor. This adjustable artificial pelvis was designed by the professor WanPeng Xu. Simple structure, safely fix, convenient setting, the transmission of mechanics approach to physical request, reserve and rebuild the functional hip joint, we could do biologic repair around the artificial pelvic, the patients can walk independently, pain was disappeared after operation, those are all advantages of this operation. Patients can do functional exercises earlier and can get better active function than the patients who did the other operation. The result was satisfied in the early follow up.3. Embolization treated to the pelvic tumor target Vascular Preoperative can reduce bleeding, risk of surgery and increase the rate of tumor resection completely, improving the efficacy of surgical treatment.