Pelvic Ring Reconstruction with Vascularized Bone Flaps Reduces Compensatory Scoliosis After External Hemipelvectomy.

IF 3.2 2区医学 Q1 SURGERY

Plastic and reconstructive surgery Pub Date : 2025-06-10 DOI:10.1097/PRS.0000000000012241

Praneet S Paidisetty, Karthik Tappa, Rami Elmorsi, Margaret S Roubaud, Matthew M Hanasono, David M Adelman, Shalin S Patel, Justin E Bird, Valerae O Lewis, Patrick P Lin, Alexander F Mericli

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引用次数: 0

Abstract

Background: External hemipelvectomy (EH) is a complex amputation that removes the hemipelvis and leg, most commonly performed to resect a locally advanced pelvic malignancy. This destabilizes the spinopelvic anatomy and may result in a compensatory scoliosis (CS) to maintain an upright posture. We hypothesized pelvic ring reconstruction with vascularized bone (VB) will reduce CS and improve functional outcomes.

Methods: We conducted a retrospective cohort study of patients who underwent an EH between 1/2004 and 5/2023. Patients were categorized by use of VB or not (NVB). The primary outcome was CS (Cobb angle >10 degrees on imaging >10 months post-procedure). Secondary outcomes included surgical complications and functional outcomes.

Results: We identified 58 reconstructions (29 VB; 29 NVB). Median follow-up (months) for VB was 25.9 (interquartile range=34.6) and NVB was 16.1 (interquartile range=114.9). For VB, fibula (41.4%) and tibia (37.9%) flaps were most common, including 15 pedicled and 14 free filet flaps. Median time to full union in months was 8.8 (range=3.4-11). CS was diagnosed in 22.2% and 78.6% of VB and NVB patients, respectively (p=0.004). Median Cobb angle for VB was 8 degrees (range=2-21) and 15.1 degrees (range=3-30) for NVB (p=0.02). The overall complication rate was not different between the two groups. Similar proportions of VB and NVB patients tolerated prostheses (34.5% vs. 32.1%) and were reliant on a wheelchair (65.5% vs. 60.7%), respectively.

Conclusion: Pelvic ring reconstruction with VB after EH appears to reduce the incidence and severity of CS, without increasing complication rates.

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带血管骨瓣骨盆环重建可减少半骨盆外切除术后代偿性脊柱侧凸。

背景：外半骨盆切除术（EH）是一种复杂的截肢手术，切除了半骨盆和腿部，最常用于切除局部晚期盆腔恶性肿瘤。这破坏了脊柱骨盆解剖结构的稳定性，并可能导致代偿性脊柱侧凸（CS）以保持直立姿势。我们假设用带血管的骨（VB）重建骨盆环可以减少CS并改善功能结果。方法：我们对2004年1月至2023年5月期间发生EH的患者进行了回顾性队列研究。根据是否使用VB （NVB）对患者进行分类。主要预后为CS（术后10个月影像学上Cobb角>0度）。次要结局包括手术并发症和功能结局。结果：共鉴定出58个重建体(29个VB；29 NVB)。VB的中位随访（月）为25.9（四分位数范围=34.6），NVB为16.1（四分位数范围=114.9）。对于VB，最常见的是腓骨（41.4%）和胫骨（37.9%）皮瓣，其中带蒂皮瓣15个，游离皮瓣14个。数月至完全愈合的中位时间为8.8（范围=3.4-11）。VB和NVB的CS检出率分别为22.2%和78.6% （p=0.004）。VB的Cobb角中位数为8度（范围=2-21），NVB的Cobb角中位数为15.1度（范围=3-30）（p=0.02）。两组总并发症发生率无明显差异。VB和NVB患者耐受假体的比例相似（34.5%对32.1%），依赖轮椅的比例相似（65.5%对60.7%）。结论：EH后盆腔环VB重建可降低CS的发生率和严重程度，且未增加并发症发生率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Plastic and reconstructive surgery 医学-外科

CiteScore

5.00

自引率

13.90%

发文量

1436

审稿时长

1.5 months

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