Limb-salvage Operation for Pelvic Bone Tumors / 대한정형외과학회잡지

ABSTRACT

From Sept. 1987 to Mar. 1993, 14 cases of pelvic bone tumors took surgical treatment. Male to female ratio was 77, with an average age of 31.9 years. Pathological diagnosis were chondrosarcoma 7(1 ; secondary), metastatic thyroid cancer 2, and each one case of giant cell tumor, desmoplastic fibroma, metastatic synovial sarcoma, malignant fibrous histiocytoma(MFH), and enchondroma. According to the Enneking's classification for the type of surgical resection, we performed 4 cases of type II+III resection, 4 type IA, 2 type I+II, 2 type III, and each one of II and IIA+III. Types of reconstruction were hip fusion(3 cases), heat treated autogenous bone graft combined with total hip replacement arthroplasty(4), bone graft(2), cement spacer(1) or saddle prothesis(1). Simple resection was done for 3 cases. Wide surgical margin was achieved in 12 cases, marginal margin in 1 and intralesional magin in 1. Complications occurred in 3 cases(21.4%) 1 graft failure ; 1 lymphedema ; and 1 delayed union. The average follow-up period was 27.4(8-60) months. During follow up, lung metastasis developed in MFH case but no local recurrence was noted in all. By the criteria of American Musculoskeletal Tumor Society(MSTS), the average score for functional activities was 21(70% of normal). The function of the extremity with reconstructed or undestroyed pelvic ring was better than that with disrupted pelvic ring(functional scores ; 24.6 vs 12.3 respectively). Due to the Korean life style using hypocaust, fused hip was not good for indoor activity. For the malignant pelvic bone tumor not involving femoral neurovascular bundle, limb-salvage using internal pelvectomy and reconstruction of pelvic ring can be indicated as a surgical procedure, instead of the hindquarter amputation.