| Background:Bone tumor was a type of tumor that occurs in the bones,and it can be divided into malignant,intermediate and benign tumors according to the degree of malignancy.The clinical manifestations of bone tumors in different sites and pathological types were also varied.While pain was the most common symptom.The pelvis was located at the junction of trunk and lower limbs,and its anatomical structure was complex,which contains many important organs.The pelvis plays an important role in protecting,supporting and moving the human body.Bone tumors occurring in the pelvis,especially malignant bone tumors,can seriously affect the lower limb function of patients,reduce the quality of life,and even threaten life and health.At present,the main treatment of malignant pelvic tumor was to surgically resect the lesion and reconstruct the pelvic ring,then combine with adjuvant therapy such as radiotherapy or chemotherapy,so as to save the patient’s life and lower limb function.Purpose:1.By reviewing the data of patients with primary pelvic tumors admitted to the Department of Orthopedic Surgery,Xijing Hospital,Air Force Medical University in recent 20 years,this paper analyzed the disease spectrum characteristics,to improve the understanding level of primary pelvic tumors,puts forward prevention and treatment suggestions and enriches the epidemiological data in China.2.A retrospective comparative study was conducted to compare the efficacy of two reconstruction methods after resection of primary pelvic malignancies.To explore the safety and effectiveness of 3D printed personalized prosthesis in reconstruction of pelvic ring,and observe its advantages compared with screw-rod-cage system(SRCS)reconstruction.So as to provide a new option for surgical treatment of pelvic tumors.Methods:1.According to the inclusion and exclusion criteria,the data of patients with primary pelvic tumors admitted to the Department of Orthopedic Surgery,Xijing Hospital,Air Force Medical University from January 2000 to December 2019 were collected.Data including age,sex,pathological type,tumor site and first symptoms were collected.According to WHO(2020)classification standard of bone tumors,the pathological types were corrected.The data were collected and the characteristics of primary pelvic tumor disease spectrum were analyzed.The data were statistically analyzed by SPSS 25.0.2.According to the inclusion and exclusion criteria,the data of patients with primary pelvic malignant tumor admitted to the Department of Orthopedic Surgery,Xijing Hospital from January 2010 to December 2019 were collected.Data including patient’s age,sex,pathological type,resection type,operation time,intraoperative bleeding were collected.Regular follow-up plans were arranged for all patients,and the follow-up time was 2 years.Follow-up included physical examination,imaging examination,laboratory examination,and functional evaluation The evaluation indexes include general situation,postoperative complications,survival status,imaging indexes and postoperative function evaluation.The data were statistically analyzed by SPSS 25.0 or Graph Pad Prism 9.Results:1.Disease spectrum analysis of primary pelvic tumor.(1)A total of 517 cases were included in this study,including 277 males and 240 females.Giant cell tumor of bone(GCTB)was the most common type,accounting for11.4%.The median onset age was 36.0 years old,and the age of 11-20 years old was the largest group,accounting for 18.6%.And 35.6% of pelvic tumors invaded area Ⅳ,and22.6% involved two or more areas.The most common symptom of patients was pain,accounting for 70.1%.(2)There were 264 cases of malignant tumors,including 155 males and 109 females,accounting for 51.1% of all tumors.Chondrosarcoma accounting for 20.8%,followed by chordoma 18.2%,osteosarcoma 14.7%,and Ewing sarcoma /PNET 13.6%.The median onset age of malignant tumor was 40.0 years old,and the age of 51-60 years old was the largest group,accounting for 20.1%.And 34.8% of malignant tumors most invaded area IV,and 36.0% invaded two or more areas.The first symptom was mainly pain,accounting for 83.3%.The median onset age of chondrosarcoma was 43.0 years old,with 34.5% of chondrosarcoma most invaded area II+III,and 60.0% invaded two or more areas.The median onset age of chordoma was 52.5 years old,and 97.9% of chordoma invaded area IV.The median onset age of osteosarcoma was 34.0 years old,with 33.3% of osteosarcoma invaded area I and 48.7% invaded two or more areas.The median onset age of Ewing sarcoma /PNET was 14.5 years old,with 27.8% of the patients most invaded area IV and 47.2% invaded two or more areas.(3)There were 88 cases of intermediate tumors,including 38 males and 50 females,accounting for 17.0% of all tumors.GCTB accounting for 67.0%,followed by Langerhans cell histiocytosis(15.9%).The median onset age of intermediate tumors was 31.5 years old,and the most frequent invasion site was area Ⅳ,accounting for 54.5%.The first symptom was mainly pain,accounting for 86.4%.The median onset age of GCTB was34.0 years old,and the most frequent invasion site was area Ⅳ,accounting for 55.9%.The median onset age of Langerhans cell histiocytosis was 14.0 years old,and the most common invaded site was area Ⅳ,accounting for 35.7%.(4)There were 165 cases of benign tumors,including 84 males and 81 females,accounting for 31.9% of all tumors.Neurilemmoma accounting for 21.2%,followed by bone cyst 20.6%,bone fibrous dysplasia 13.9% and osteochondroma 13.3%.The median onset age of benign tumors was 32.0 years old.And the age of 21-30 years old was the largest group,accounting for 23.6%.The most common invaded site was area I,accounting for 32.1%.The first symptom was mainly pain,accounting for 67.9%,and15.2% of the patients had no obvious symptom before seeing a doctor,and the lesions were founded by imaging examination.The median onset age of neurilemmoma was 46.0years old,and the most frequent invasion of area Ⅳ was 94.3%.The median onset age of bone cyst was 29.0 years old,and the most frequent invasion of area Ⅰ was 44.1%.The median onset age of fibrous dysplasia of bone was 30.0 years old,and the most common invasion of area Ⅰ was 47.8%.The median onset age of osteochondroma was 23.0 years old,and the most common invasion of area Ⅰ was 50.0%.(5)In the gender distribution of pelvic tumors in this group,the overall male-female ratio was 1.15: 1,among which malignant tumor was 1.42: 1,intermediate tumor was 0.76:1,benign tumor was 1.04: 1,malignant tumors were more male than female,and intermediate tumors were more female than male(P=0.011).However,no statistical difference was found in gender distribution between malignant tumors and benign tumors,and between intermediate tumors and benign tumors(P>0.05).In the age distribution,pelvic malignant tumor in the onset age was 40.0(23.0,55.0),the intermediate tumor was31.5(20.3,43.8)years of age,and benign tumor was 32.0(21.0,46.0)years of age,and in patients with malignant tumor onset age is greater than the intermediate tumor and benign tumors(P(27)0.001).However,there was not statistically different in age distribution between intermediate tumors and benign tumors(P=0.432).In the distribution of tumor invasion range,the proportion of primary pelvic tumor invading two or more areas was22.6%,malignant tumor was 36.0%,intermediate tumor was 12.5%,and benign tumor was 6.7%.The invasion range of malignant tumor was obviously larger than that of intermediate tumor and benign tumor(P<0.001).There was no statistical difference between intermediate tumor and benign tumor(P=0.532).2.Retrospective comparative study of two reconstruction methods after resection of primary pelvic malignant tumor.(1)General situation: 40 cases were included in this study,including 15 cases in the3 DP group and 25 cases in the SRCS group.There was no significant difference in age,sex,maximum diameter of tumor,intraoperative blood loss,pathological diagnosis and resection type between the two groups(P>0.05).The operation time in the 3DP group was significantly shorter than that in the SRCS group(P=0.028).(2)Postoperative complications: The incidence of postoperative complications in the3 DP group was 13.3%,the SRCS group was 40.0%.There was no statistical difference between the two groups(P=0.152).K-M survival curve showed that the survival rate of prosthesis in 3DP group was significantly higher than that in the SRCS group(P=0.026).(3)Imaging indexes: All imaging indexes showed that the absolute value of the reconstructed bilateral differences of FHO,FVO,AAD and AAV in the 3DP group was smaller than that in the SRCS group,with statistical difference(P<0.05).(4)Survival status: No significant difference was noted in the incidence of recurrence,metastasis and survival status at the last follow-up between the two groups(P>0.05).K-M survival curve showed that there was no obvious difference in overall survival rate and disease-free survival rate between the two groups(P>0.05).(5)Postoperative function: The average MSTS score in 3DP group was 81.5±9.7%,and the average HHS was 83.0±9.1.The average MSTS score in the SRCS group was73.3±12.0%,and the average HHS was 73.5±12.6.The MSTS score and HHS score of the3 DP group were significantly higher than those of the SRCS group(P<0.05).Conclusion:1.Primary pelvic tumors need to be focused on the adolescents,middle-aged and elderly population,especially male population.The sacrum and ilium were the most common sites of primary pelvic tumors,and pain and mass in the pelvic region need attention.2.Compared with the SRCS,3D printed personalized prosthesis was as safe and effective in reconstructing bone defect after tumor resection,but also more accurate and time-saving,and can achieve better postoperative function.It was a nice choice for surgical treatment of pelvic tumors. |
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