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1、同侧股骨移植重建骨盆肿瘤切除后骨缺损DavidJBiau,MD,etcHospitalCochin,Paris,France骨盆肿瘤切除后重建选择：内置假体鞍式假体大块异体骨坐股融合或髂股融合同侧股骨移植，并行全髋置换，重建骨盆环：PugetandUtheza首次于1986年提出。优点：提供生物学重建，没有异体骨移植相关的缺点如骨折、不融合等。1994—2005,13cases:9men,4women,medianage51years(22—72),7rightlimb.Chondrosarcoma:8,Metastasis(lung,kidney,etc):3,
2、Myeloma1,Radiation-inducedmalignantdisease1.MaterialsandMethodsScoringsystem:Merled’AubigneandPostel,1954,JBJS.Score:hiprangeofmovementpainWalkingability3—18pointsHostbonejunctions:plainanteroposterior,lateral,obliqueradiograghs.SurgicaltechniqueCombinedA-PsurgicalapproachResectionoft
3、umorReconstructionofthepelvicdefectwithfemoralautograftInsertionofaconventionalTHPSurgicaltechnique将髂腰肌肌腱自小转子处剥离，股骨近端用作自体植骨，大转子区保留，以保留臀中肌和股外侧肌止点。股骨头与髂股相接，股骨干端与耻骨支或耻骨联合相接。牢固内固定。在转子区重造新髋臼，并植入聚乙烯臼杯。置入长柄水泥股骨假体，调整肢体长度，股骨内侧骨缺损区以异体骨填充，钢丝固定。Operationmediantime:290mins,280—350mins.Medianbloodt
4、ransfused:4units,3—8.Medianstemlength:200cm,200—250cm.Mediancupdiameter:40mm,40—48mm.Contaminationofjoint:3cases.MaterialsandMethodsPostoperativecare:Painmanagement,operativesitecare,anticoagulation.Coaptation-suspension:2weeks.Spicacast:6weeks.Weight-bearing:2months.MaterialsandMetho
5、dsResultsFollow-up:Medianduration:49months(12—107months)7aliveanddisease-free,6diedfrommetastasis5hadcomplications:1woundnecrosis,1superficialwoundinfection,1DVT,1dislocation,1transientsciaticnervepalsy.Medianscore:15points(13.8—17points).7patientswalkwithcanes.2patientshad2-cmlimbdis
6、crepancy,11patients＜1cm.6patientsnoallograftincorporation,5allograftresorption.Mechanicalcomplications:5patients1:acetabularlooseningwithcupmigration,35months,revision:addedametallicreinforcementringanda42-mmall-polyethylenecementedcupdislocation,3.5months,reduction.1:fractureofgrafta
7、ndlooseningandmigrationofcup,10months,revision:allograftandmetallicreinforcementringanda42-mmall-polyethylenecementedcupdislocation,1months,revision:a44-mmall-polyethylenecementedcup,stempositionedhigherandalongneck(+3mm),anartificialligamenttolimittheinternalrotation.1:slowmigrationo
8、fcup,
