Pelvic reconstruction with compound osteosynthesis following hemipelvectomy: A clinical study
Orthopaedic Hospital Volmarstein, Department of Tumour & Revision Surgery, Lothar-Gau-Str. 11, D-58300 Wetter, and The University of Muenster, Germany.Bone and Joint Journal (Impact Factor: 1.96). 10/2013; 95-B(10):1410-1416. DOI: 10.1302/0301-620X.95B10.31123
To date, all surgical techniques used for reconstruction of the pelvic ring following supra-acetabular tumour resection produce high complication rates. We evaluated the clinical, oncological and functional outcomes of a cohort of 35 patients (15 men and 20 women), including 21 Ewing's sarcomas, six chondrosarcomas, three sarcomas not otherwise specified, one osteosarcoma, two osseous malignant fibrous histiocytomas, one synovial cell sarcoma and one metastasis. The mean age of the patients was 31 years (8 to 79) and the latest follow-up was carried out at a mean of 46 months (1.9 to 139.5) post-operatively. We undertook a functional reconstruction of the pelvic ring using polyaxial screws and titanium rods. In 31 patients (89%) the construct was encased in antibiotic-impregnated polymethylmethacrylate. Preservation of the extremities was possible for all patients. The survival rate at three years was 93.9% (95% confidence interval (CI) 77.9 to 98.4), at five years it was 82.4% (95% CI 57.6 to 93.4). For the 21 patients with Ewing's sarcoma it was 95.2% (95% CI 70.7 to 99.3) and 81.5% (95% CI 52.0 to 93.8), respectively. Wound healing problems were observed in eight patients, deep infection in five and clinically asymptomatic breakage of the screws in six. The five-year implant survival was 93.3% (95% CI 57.8 to 95.7). Patients were mobilised at a mean of 3.5 weeks (1 to 7) post-operatively. A post-operative neurological defect occurred in 12 patients. The mean Musculoskeletal Tumor Society score at last available follow-up was 21.2 (10 to 27). This reconstruction technique is characterised by simple and oncologically appropriate applicability, achieving high primary stability that allows early mobilisation, good functional results and relatively low complication rates. Cite this article: Bone Joint J 2013;95-B:1410-16.
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ABSTRACT: Background: The modular hemipelvic prosthesis has been used in patient of Type I-IV pelvic tumor with good outcomes, but how to keep the stability between the prosthesis and the residual sacrum is a problem. An additional screw-rod system seems to solve it, but its biomechanical characters are still not well understood, which need experimental evaluation. Methods: Six pelvic specimens were prepared in three conditions (normal intact pelvis, "normal"; the pelvis of left Type I-IV defect and implanted with prosthesis without/with additional screw-rod system, "rod-" and "rod+"). Compressing biomechanical experiments (50-500N) were performed in these three conditions, respectively. Results: The loadings during the experiments are in accordance with the linear elastic control mode. Under the increasing loading, the implanted pelvises displaced asymmetrically, unlike normal intact pelvis. The vertical displacement of "rod+" changed significantly, whereas "rod-" did not. For both implanted pelvis, right side displaced less than left side (P values <0.05). Conclusions: The implanted pelvis showed asymmetric displacement under loading, where healthy side displaced more. The implanted pelvis plus screw-rod system showed less displacement at implanted side but more at contralateral side in comparison with those without screw-rod system.Chinese Journal of Cancer Research 08/2014; 26(4):431-6. DOI:10.3978/j.issn.1000-9604.2014.08.13 · 1.94 Impact Factor
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