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Function after pelvic tumour resection involving the acetabular ring

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Summary

Seven patients subjected to pelvic tumour resection involving the acetabular ring were analyzed with respect to function. In addition to conventional clinical assessment gait was analyzed objectively by means of an electronic walk-way and residual hip-muscle power tested by means of a Cybex II dynamometer.

Functional results reported by the patients with respect to pain, walking and working capacity appeared better than those elicited by clinical examination. All patients exhibited a marked pelvic tilt and a positive Trendelenburg sign. Only one patient walked without any kind of support. Leg-length discrepancy was on average 6 cm. Objective gait analysis disclosed that all patients had reduced weight-bearing time on the operated side as compared to the non-operated. This, however, was clearly less pronounced for those patients who appeared best with respect to pain, walking and working capacity. These patients also showed the best hip extension power which appeared more important from a functional point of view than hip flexion and, surprisingly, hip abduction power.

Radiographic examination showed that bony support for the proximal femur, provided either by the formation of a bone shelf from the remaining iliac bone or by the remaining iliac bone itself, was of decisive importance for function.

The results of the present study show that pelvic tumour resection involving the acetabular ring, provided radical tumour removal can be achieved, constitutes a feasible alternative to hemipelvectomy from a functional point of view.

Résumé

Sept malades ayant subi pour une tumeur pelvienne une résection iliaque intéressant l'anneau obturateur ont été étudiés sur le plan du résultat fonctionnel. La marche a été analysée cliniquement et objectivement au moyen d'un plateau de marche électronique et la force des muscles de la hanche évaluée à l'aide d'un dynamomètre Cybex II.

L'estimation du résultat fonctionnel faite par les malades eux-mêmes, d'après la douleur et les possibilités de marche et de travail, est meilleure que celle qui ressort de l'examen clinique. Tous les opérés présentent une importante claudication et un signe de Trendelenburg positif. Un seul malade est capable de marcher sans canne. Le raccourcissement est en moyenne de 6 cm. L'analyse objective de la marche révèle que tous les malades ont une phase d'appui diminuée du côté opéré comparativement au côté sain. Ceci, toutefois, est nettement moins marqué chez ceux dont le résultat est meilleur en ce qui concerne la douleur et les possibilités de marche et de travail. Ces malades présentent également une meilleure force d'extension de la hanche, ce qui paraît plus important du point de vue fonctionnel que la force de flexion et même, de façcon étonnante, que celle d'abduction.

L'examen radiologique montre que l'existence d'un appui entre l'extrémité supérieure du fémur et l'os iliaque restant, parfois par l'intermédiaire d'une butée spontanée, joue un rôle majeur dans la fonction.

On peut conclure de cette étude que la résection iliaque intéressant l'anneau obturateur, dans la mesure où elle assure une exérèse radicale de la tumeur pelvienne, constitue, sur le plan fonctionnel, une alternative valable de l'amputation inter-ilioabdominale.

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Nilsonne, U., Kreicbergs, A., Olsson, E. et al. Function after pelvic tumour resection involving the acetabular ring. International Orthopaedics 6, 27–33 (1982). https://doi.org/10.1007/BF00267812

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