Abstract:

BACKGROUND: Limb length discrepancy (LLD) influences the effect of limb-salvage treatment. Although through perspective of monitoring to ensure limbs isometry during operation, it is still a difficult problem to grasp, especially for limb-salvage treatment of malignant tumors in acetabular region. In other aspects of orthopedics, such as spinal column and joint, navigation technology has been more used to the installation of internal fixation and prosthetic placement.
OBJECTIVE: To retrospectively analyze the effect of limb-salvage treatment of malignant tumors in acetabular region under the computer-assisted navigation system.
METHODS: From January 2001 to June 2009, a total of 11 malignant pelvic bone tumors cases received treatment at the Department of Orthopedics, Shanghai Ruijin Hospital were selected. They underwent preoperative pathological diagnosis; custom-made prosthesis reconstruction was applied after tumor resection, including 8 cases underwent normal limb salvage surgery; the remaining 3 cases were treated with computer-assisted navigation limb salvage. The pelvic malignancies resection scopes of all patients were located in acetabular surrounding region (pelvic areaⅡ). Patients were examined clinically and radiographically after the treatment of limb salvage, and were assessed by lower extremity limb salvage function musculoskeletal tumor society (MSTS) score.
RESULTS AND CONCLUSION: In 12-16 months follow-up, 8 cases with normal limb salvage, the mean operation time-consuming was 7.6 hours, and the mean volume of blood loss was 2 400 mL. One case was died of lung metastasis at 3 years after surgery, one case suffered from amputation because of local recurrence. In addition to these two patients, the deviation of acetabular prosthesis exceeded 2 cm to form LLD in 3 cases after the treatment of limb salvage. The mean MSTS score was 20.3 points. Among the 3 cases treated with computer-assisted navigation limb salvage, the mean operation time-consuming was 8.3 hours, and the mean volume of blood loss was 2 100 mL. No cases represented LLD. The mean MSTS score was 21.7 points. It is indicated that limb-salvage treatment of malignant tumors in the acetabular region under the computer-assisted navigation system can cut bone precisely, place prosthesis accurately, reduce the incidence rate of LLD in the acetabular region after the treatment of limb salvage, and improve affected limb function.