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Pelvic ring reconstruction with a double-barreled free vascularized fibula graft after resection of malignant pelvic bone tumor.
Arch Orthop Trauma Surg. 2015 May; 135(5):619-25.AO

Abstract

INTRODUCTION

In patients undergoing limb-salvage internal hemipelvectomy, pelvic ring reconstruction is mandatory to maintain the stability of the pelvis and the spinal column, which finally expected to achieve a good functional outcome. However, no optimal reconstruction method has been established. In addition, no previous reports have highlighted the long-term complications of pelvic ring reconstruction after internal hemipelvectomy. We aimed to analyze the outcome of pelvic ring reconstruction using a double-barreled free vascularized fibula graft (VFG) after internal hemipelvectomy with special reference to long-term complications.

MATERIALS AND METHODS

We conducted a retrospective review of 9 consecutive patients (5 male, 4 female; mean age 31 years) who underwent pelvic ring reconstruction using a double-barreled free VFG after internal hemipelvectomy (P1, n = 4; P1 + 4, n = 3; P1 + 2, n = 2) at our institution between 1998 and 2013. The mean follow-up period was 55 months (range 3-131 months).

RESULTS

The mean length of the bone defect was 9 cm. The methods of fixation included a Cotrel-Dubosset rod (n = 4), screw (n = 3), and screw and plate (n = 2). Bone union was achieved in 5 of 8 patients (63 %) over a 1-year follow-up. The mean period required for bone union was 5.4 months (range 3-7 months). There were 3 early postoperative complications: 2 deep infections resulting in graft removal and 1 implant failure resulting in non-union. Among 3 patients, 2 developed scoliosis within 5 years. One patient developed lumbar disc hernia as a result of scoliosis, for which surgical intervention was required. The mean Musculoskeletal Tumor Society score was 57 % at the last follow-up.

CONCLUSIONS

In conclusion, this reconstruction method can achieve an early and high rate of bone union and provide good functional outcome. However, follow-up with careful attention to postoperative complications, including deep infection in the early postoperative period and spinal deformity in the long term, is necessary.

Authors+Show Affiliations

Department of Musculoskeletal Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25795428

Citation

Ogura, Koichi, et al. "Pelvic Ring Reconstruction With a Double-barreled Free Vascularized Fibula Graft After Resection of Malignant Pelvic Bone Tumor." Archives of Orthopaedic and Trauma Surgery, vol. 135, no. 5, 2015, pp. 619-25.
Ogura K, Sakuraba M, Miyamoto S, et al. Pelvic ring reconstruction with a double-barreled free vascularized fibula graft after resection of malignant pelvic bone tumor. Arch Orthop Trauma Surg. 2015;135(5):619-25.
Ogura, K., Sakuraba, M., Miyamoto, S., Fujiwara, T., Chuman, H., & Kawai, A. (2015). Pelvic ring reconstruction with a double-barreled free vascularized fibula graft after resection of malignant pelvic bone tumor. Archives of Orthopaedic and Trauma Surgery, 135(5), 619-25. https://doi.org/10.1007/s00402-015-2197-7
Ogura K, et al. Pelvic Ring Reconstruction With a Double-barreled Free Vascularized Fibula Graft After Resection of Malignant Pelvic Bone Tumor. Arch Orthop Trauma Surg. 2015;135(5):619-25. PubMed PMID: 25795428.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pelvic ring reconstruction with a double-barreled free vascularized fibula graft after resection of malignant pelvic bone tumor. AU - Ogura,Koichi, AU - Sakuraba,Minoru, AU - Miyamoto,Shimpei, AU - Fujiwara,Tomohiro, AU - Chuman,Hirokazu, AU - Kawai,Akira, Y1 - 2015/03/21/ PY - 2014/10/19/received PY - 2015/3/22/entrez PY - 2015/3/22/pubmed PY - 2015/12/24/medline SP - 619 EP - 25 JF - Archives of orthopaedic and trauma surgery JO - Arch Orthop Trauma Surg VL - 135 IS - 5 N2 - INTRODUCTION: In patients undergoing limb-salvage internal hemipelvectomy, pelvic ring reconstruction is mandatory to maintain the stability of the pelvis and the spinal column, which finally expected to achieve a good functional outcome. However, no optimal reconstruction method has been established. In addition, no previous reports have highlighted the long-term complications of pelvic ring reconstruction after internal hemipelvectomy. We aimed to analyze the outcome of pelvic ring reconstruction using a double-barreled free vascularized fibula graft (VFG) after internal hemipelvectomy with special reference to long-term complications. MATERIALS AND METHODS: We conducted a retrospective review of 9 consecutive patients (5 male, 4 female; mean age 31 years) who underwent pelvic ring reconstruction using a double-barreled free VFG after internal hemipelvectomy (P1, n = 4; P1 + 4, n = 3; P1 + 2, n = 2) at our institution between 1998 and 2013. The mean follow-up period was 55 months (range 3-131 months). RESULTS: The mean length of the bone defect was 9 cm. The methods of fixation included a Cotrel-Dubosset rod (n = 4), screw (n = 3), and screw and plate (n = 2). Bone union was achieved in 5 of 8 patients (63 %) over a 1-year follow-up. The mean period required for bone union was 5.4 months (range 3-7 months). There were 3 early postoperative complications: 2 deep infections resulting in graft removal and 1 implant failure resulting in non-union. Among 3 patients, 2 developed scoliosis within 5 years. One patient developed lumbar disc hernia as a result of scoliosis, for which surgical intervention was required. The mean Musculoskeletal Tumor Society score was 57 % at the last follow-up. CONCLUSIONS: In conclusion, this reconstruction method can achieve an early and high rate of bone union and provide good functional outcome. However, follow-up with careful attention to postoperative complications, including deep infection in the early postoperative period and spinal deformity in the long term, is necessary. SN - 1434-3916 UR - https://www.unboundmedicine.com/medline/citation/25795428/Pelvic_ring_reconstruction_with_a_double_barreled_free_vascularized_fibula_graft_after_resection_of_malignant_pelvic_bone_tumor_ L2 - https://dx.doi.org/10.1007/s00402-015-2197-7 DB - PRIME DP - Unbound Medicine ER -