经皮髋臼成形术治疗Harrington Ⅰ型髋臼转移瘤的效果

Efficacy of percutaneous acetabular plasty in the treatment of Harrington Type I periacetabular metastatic tumors

摘要

目的 评估经皮髋臼成形术治疗Harrington I型髋臼转移瘤的临床疗效及安全性。方法 2013年12月至2023年12月河南省肿瘤医院骨与软组织肿瘤科收治的Harrington I型髋臼转移瘤患者16例；中位年龄55（41~73）岁；中位随访时间26.5（4~72）个月。11例患者接受单纯经皮髋臼成形术治疗；5例患者接受髋臼成形术联合关节置换或其他外科手术治疗。分别于术前、术后评估疼痛视觉模拟评分（VAS）、美国东部肿瘤协作组体能状态评分（ECOG）、疼痛功能评分（PFAS）、肌肉骨骼肿瘤学会系统（MSTS）评分、Harris髋关节评分，并记录术中术后的并发症，观察是否需要额外手术治疗。患者术后每3个月进行影像学检查及时评估病情变化。结果 16例患者均顺利完成手术，且在随访期间未进行其他手术治疗。VAS评分由术前的（7.06±1.00）分显著改善至术后末次随访的（0.22±0.67）分，提示治疗在缓解疼痛方面效果显著。ECOG评分、PFAS、MSTS评分和Harris髋关节评分均呈不同程度的改善。术后4例出现骨水泥外渗；其中3例发生在穿刺通道处；1例因髂骨内板破裂引起；但均未引起明显临床症状，表明治疗方案安全性良好。结论 经皮髋臼成形术能有效缓解Harrington I型髋臼转移瘤患者的疼痛，改善运动功能，且治疗方案安全性高，风险可控。患者术后无需额外手术，能够实现中远期的症状控制。

Abstract

Objective To evaluate the clinical efficacy and safety of percutaneous acetabular plasty for Harrington Type I periacetabular metastatic tumors. Methods This retrospective study included 16 patients with Harrington Type I periacetabular metastatic tumors treated in Department of Bone and Soft Tissue Cancer, the Affiliated Cancer Hospital of Zhengzhou University from December 2013 to December 2023. The median age of the patients was 55 (41-73) years. The median follow-up time was 26.5 (4-72) months. Eleven patients received percutaneous acetabular plasty alone, while five patients underwent acetabular plasty combined with hip replacement or other surgical interventions. Pre-and post-operative evaluations included visual analog scale (VAS) scores, eastern cooperative oncology group (ECOG) scores, pain and function scores (PFAS), musculoskeletal tumor society system (MSTS) scores, and Harris hip scores, along with intraoperative and postoperative complications to determine if additional surgeries were required. All patients underwent imaging every three months postoperatively to monitor the progression. Results All 16 patients successfully completed the surgery with no additional required surgeries during follow-up. The VAS score significantly improved from 7.06±1.00 preoperatively to 0.22±0.67 at the final follow-up, indicating significant pain relief. ECOG scores, PFAS, MSTS, and Harris hip scores all showed varying degrees of improvement. Postoperatively; only four patients experienced extravasation with three occurrences at the puncture site; and one due to iliac bone inner plate rupture. However, none of these cases resulted in significant clinical symptoms, suggesting that the treatment approach is safe. Conclusions Percutaneous acetabular plasty is an effective method for alleviating pain and improving function in patients with Harrington Type I periacetabular metastatic tumors. This treatment is safe, with a low risk of complications, and does not require additional surgeries, allowing for long-term symptom control.

关键词

转移瘤切除术 / 髋臼成形术 / Harrington I型

Key words

Metastasectomy / Acetabuloplasty / Harrington type Ⅰ

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基金资助

河南省医学科技攻关计划项目(242102311057)