Percutaneous hollow screw internal fixation combined with cementoplasty in treatment of periacetabular metastasis <italic/>_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YE Xuenian , YAO Zhipeng , JIANG Ming , SHI Tan ,  ZHU Wenxiong

Department of Orthopedics, Affiliated Dongguan Hospital, Southern Medical University (Dongguan People’s Hospital), Dongguan Key Laboratory of Basic, Clinical and Digital Research on Common Orthopedic Diseases, Dongguan Guangdong, 523059, P. R. China;

Corresponding author：

ZHU Wenxiong, Email: 1768832621@qq.com

Keywords：

Periacetabular metastasis; hollow screw; percutaneous cementoplasty

DOI：

10.7507/1002-1892.202211038

Video：

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Objective To explore the percutaneous hollow screw internal fixation combined with cementoplasty in the treatment of periacetabular metastasis. Methods A retrospective study was performed on 16 patients with periacetabular metastasis who were treated with percutaneous hollow screw internal fixation combined with cementoplasty between May 2020 and May 2021. There were 9 males and 7 females. The age ranged from 40 to 73 years, with an average of 53.6 years. The tumor involved around the acetabulum, and 6 cases were located on the left and 10 cases on the right. Operation time, frequency of fluoroscopy, bed rest time, and complications were recorded. Before operation, and at 1 weeks, 3 months after operation, the visual analogue scale (VAS) score was used to evaluate the pain degree, the short-form 36 health survey scale (SF-36) score was used to evaluate the quality of life. At 3 months after operation, the Musculoskeletal Tumor Society (MSTS) scoring system was used to evaluate the functional recovery of patients. During follow-up, the loosening of internal fixator and bone cement leakage were observed by X-ray film. Results All patients were performed operation successfully. The operation time ranged from 57 to 82 minutes, with an average of 70.4 minutes. The frequency of intraoperative fluoroscopy was 16-34 times, with an average of 23.1 times. After operation, 1 case of incision hematoma and 1 case of scrotal edema occurred. All patients felt the pain relieved after operation. The patients started walking at 1-3 days after operation, with an average of 1.4 days. All patients were followed up 6-12 months (mean 9.7 months). The VAS and SF-36 scores significantly improved after operation when compared with the preoperative scores, and the scores at 3 months after operation were significant better than those at 1 week after operation (P<0.05). At 3 months after operation, the MSTS score ranged from 9 to 27, with an average of 19.8. Among them, 3 cases were excellent (18.75%), 8 cases were good (50%), 3 cases were fair (18.75%), and 2 cases were poor (12.5%). The excellent and good rate was 68.75%. And 11 patients returned to normal walking, 3 had mild claudication, and 2 had obvious claudication. Radiological examination showed that there were 2 cases of bone cement leakage after operation, and there was no internal fixator loosening or displacement. Conclusion Percutaneous hollow screw internal fixation combined with cementoplasty can effectively relieve pain and improve the quality of life of patients with periacetabular metastasis.

Citation： YE Xuenian, YAO Zhipeng, JIANG Ming, SHI Tan, ZHU Wenxiong. Percutaneous hollow screw internal fixation combined with cementoplasty in treatment of periacetabular metastasis . Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(4): 438-442. doi: 10.7507/1002-1892.202211038 Copy

1.	Scaramuzzo L, Maccauro G, Rossi B, et al. Quality of life in patients following percutaneous PMMA acetabuloplasty for acetabular metastasis due to carcinoma. Acta Orthop Belg, 2009, 75(4): 484-489.
2.	Pusceddu C, Sotgia B, Fele RM, et al. Combined microwave ablation and cementoplasty in patients with painful bone metastases at high risk of fracture. Cardiovasc Intervent Radiol, 2016, 39(1): 74-80.
3.	Buy X, Cazzato RL, Catena V, et al. Image-guided bone consolidation in oncology: Cementoplasty and percutaneous screw fixation. Bull Cancer, 2017, 104(5): 423-432.
4.	Morris MT, Alder KD, Moushey A, et al. Biomechanical restoration of metastatic cancer-induced peri-acetabular bone defects by ablation-osteoplasty-reinforcement-internal fixation technique (AORIF): To screw or not to screw? Clin Biomech (Bristol, Avon), 2022, 92: 105565. doi: 10.1016/j.clinbiomech.2021.105565.
5.	Cazzato RL, Koch G, Buy X, et al. Percutaneous image-guided screw fixation of bone lesions in cancer patients: Double-centre analysis of outcomes including local evolution of the treated focus. Cardiovasc Intervent Radiol, 2016, 39(10): 1455-1463.
6.	Pusceddu C, Fancellu A, Ballicu N, et al. CT-guided percutaneous screw fixation plus cementoplasty in the treatment of painful bone metastases with fractures or a high risk of pathological fracture. Skeletal Radiol, 2017, 46(4): 539-545.
7.	Hartung MP, Tutton SM, Hohenwalter EJ, et al. Safety and efficacy of minimally invasive acetabular stabilization for periacetabular metastatic disease with thermal ablation and augmented screw fixation. J Vasc Interv Radiol, 2016, 27(5): 682-688.
8.	Coupal TM, Pennycooke K, Mallinson PI, et al. The hopeless case? Palliative cryoablation and cementoplasty procedures for palliation of large pelvic bone metastases. Pain Physician, 2017, 20(7): E1053-E1061.
9.	Powell DK, Ardestani A. Percutaneous screw-reinforced cement osteoplasty for palliation of postremission pain in larger lytic sacro-acetabular iliac cavities. Radiol Case Rep, 2019, 14(9): 1093-1099.
10.	胡宏志, 邵增务. 髋臼周围恶性肿瘤的外科治疗进展. 华中科技大学学报 (医学版), 2019, 48(2): 228-232.
11.	Spinelli MS, Ziranu A, Piccioli A, et al. Surgical treatment of acetabular metastasis. Eur Rev Med Pharmacol Sci, 2016, 20(14): 3005-3010.
12.	杨正明, 陶惠民, 叶招明, 等. 髋臼周围恶性肿瘤切除后股骨头旷置术的临床应用. 中华外科杂志, 2011, 49(1): 79-82.
13.	郭卫, 孙馨, 姬涛, 等. 髋臼转移瘤的外科治疗. 中华外科杂志, 2009, 47(22): 1718-1721.
14.	郭征, 王臻, 李明全, 等. 髋臼周围转移瘤的切除与重建. 中华骨科杂志, 2006, 26(4): 232-237.
15.	Kiatisevi P, Sukunthanak B, Pakpianpairoj C, et al. Functional outcome and complications following reconstruction for Harrington class Ⅱ and Ⅲ periacetabular metastasis. World J Surg Oncol, 2015, 13: 4. doi: 10.1186/1477-7819-13-4.
16.	雷森林, 张闻力, 方向, 等. 微波结合刮除术治疗骨盆转移瘤的临床疗效. 中华骨科杂志, 2020, 40(16): 1063-1069.
17.	Marco RA, Sheth DS, Boland PJ, et al. Functional and oncological outcome of acetabular reconstruction for the treatment of metastatic disease. J Bone Joint Surg (Am), 2000, 82(5): 642-651.
18.	Issack PS, Kotwal SY, Lane JM. Management of metastatic bone disease of the acetabulum. J Am Acad Orthop Surg, 2013, 21(11): 685-695.
19.	Schaefer O, Lohrmann C, Markmiller M, et al. Technical innovation. Combined treatment of a spinal metastasis with radiofrequency heat ablation and vertebroplasty. AJR Am J Roentgenol, 2003, 180(4): 1075-1077.
20.	Murphy KJ, Lin DD. Vertebroplasty: a simple solution to a difficult problem. J Clin Densitom, 2001, 4(3): 189-197.
21.	Murphy KJ, Deramond H. Percutaneous vertebroplasty in benign and malignant disease. Neuroimaging Clin N Am, 2000, 10(3): 535-545.

1. Scaramuzzo L, Maccauro G, Rossi B, et al. Quality of life in patients following percutaneous PMMA acetabuloplasty for acetabular metastasis due to carcinoma. Acta Orthop Belg, 2009, 75(4): 484-489.
2. Pusceddu C, Sotgia B, Fele RM, et al. Combined microwave ablation and cementoplasty in patients with painful bone metastases at high risk of fracture. Cardiovasc Intervent Radiol, 2016, 39(1): 74-80.
3. Buy X, Cazzato RL, Catena V, et al. Image-guided bone consolidation in oncology: Cementoplasty and percutaneous screw fixation. Bull Cancer, 2017, 104(5): 423-432.
4. Morris MT, Alder KD, Moushey A, et al. Biomechanical restoration of metastatic cancer-induced peri-acetabular bone defects by ablation-osteoplasty-reinforcement-internal fixation technique (AORIF): To screw or not to screw? Clin Biomech (Bristol, Avon), 2022, 92: 105565. doi: 10.1016/j.clinbiomech.2021.105565.
5. Cazzato RL, Koch G, Buy X, et al. Percutaneous image-guided screw fixation of bone lesions in cancer patients: Double-centre analysis of outcomes including local evolution of the treated focus. Cardiovasc Intervent Radiol, 2016, 39(10): 1455-1463.
6. Pusceddu C, Fancellu A, Ballicu N, et al. CT-guided percutaneous screw fixation plus cementoplasty in the treatment of painful bone metastases with fractures or a high risk of pathological fracture. Skeletal Radiol, 2017, 46(4): 539-545.
7. Hartung MP, Tutton SM, Hohenwalter EJ, et al. Safety and efficacy of minimally invasive acetabular stabilization for periacetabular metastatic disease with thermal ablation and augmented screw fixation. J Vasc Interv Radiol, 2016, 27(5): 682-688.
8. Coupal TM, Pennycooke K, Mallinson PI, et al. The hopeless case? Palliative cryoablation and cementoplasty procedures for palliation of large pelvic bone metastases. Pain Physician, 2017, 20(7): E1053-E1061.
9. Powell DK, Ardestani A. Percutaneous screw-reinforced cement osteoplasty for palliation of postremission pain in larger lytic sacro-acetabular iliac cavities. Radiol Case Rep, 2019, 14(9): 1093-1099.
10. 胡宏志, 邵增务. 髋臼周围恶性肿瘤的外科治疗进展. 华中科技大学学报 (医学版), 2019, 48(2): 228-232.
11. Spinelli MS, Ziranu A, Piccioli A, et al. Surgical treatment of acetabular metastasis. Eur Rev Med Pharmacol Sci, 2016, 20(14): 3005-3010.
12. 杨正明, 陶惠民, 叶招明, 等. 髋臼周围恶性肿瘤切除后股骨头旷置术的临床应用. 中华外科杂志, 2011, 49(1): 79-82.
13. 郭卫, 孙馨, 姬涛, 等. 髋臼转移瘤的外科治疗. 中华外科杂志, 2009, 47(22): 1718-1721.
14. 郭征, 王臻, 李明全, 等. 髋臼周围转移瘤的切除与重建. 中华骨科杂志, 2006, 26(4): 232-237.
15. Kiatisevi P, Sukunthanak B, Pakpianpairoj C, et al. Functional outcome and complications following reconstruction for Harrington class Ⅱ and Ⅲ periacetabular metastasis. World J Surg Oncol, 2015, 13: 4. doi: 10.1186/1477-7819-13-4.
16. 雷森林, 张闻力, 方向, 等. 微波结合刮除术治疗骨盆转移瘤的临床疗效. 中华骨科杂志, 2020, 40(16): 1063-1069.
17. Marco RA, Sheth DS, Boland PJ, et al. Functional and oncological outcome of acetabular reconstruction for the treatment of metastatic disease. J Bone Joint Surg (Am), 2000, 82(5): 642-651.
18. Issack PS, Kotwal SY, Lane JM. Management of metastatic bone disease of the acetabulum. J Am Acad Orthop Surg, 2013, 21(11): 685-695.
19. Schaefer O, Lohrmann C, Markmiller M, et al. Technical innovation. Combined treatment of a spinal metastasis with radiofrequency heat ablation and vertebroplasty. AJR Am J Roentgenol, 2003, 180(4): 1075-1077.
20. Murphy KJ, Lin DD. Vertebroplasty: a simple solution to a difficult problem. J Clin Densitom, 2001, 4(3): 189-197.
21. Murphy KJ, Deramond H. Percutaneous vertebroplasty in benign and malignant disease. Neuroimaging Clin N Am, 2000, 10(3): 535-545.

Chinese Journal of Reparative and Reconstructive Surgery

Percutaneous hollow screw internal fixation combined with cementoplasty in treatment of periacetabular metastasis

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