Cimentoplastie cotyle J.Palussière

Transcript

1. Cimentoplastie cotyle J. Palussière Institut Bergonié Bordeaux 10 Février 2012
2. ACETABULUM Lytic tumoral invasion of the acetabulum is frequent causing : pathologic fractures pain disability Percutaneous cementoplasty since 1995 A.Cotten Radiology
3. ACETABULUM : When the weight-bearing part is involved Extent of dome Column involvement 3D reconstruction CT+++ to assess location/extent of the lytic process presence of cortical destruction or fracture presence of soft tissue involvement
4. How? under CT control fluoroscopy guided combining the 2 modalities general anesthesia local anesthesia + sedation
5. Is a cortical lysis a CI?
6. Is a cortical lysis a CI?
7. Is a cortical lysis a CI?
8. Is a cortical lysis a CI?
9. CT before and after
19. Sup and inf pubic rami To fill progressively in different sessions
20. Sup and Inf pubic rami : A good knowledge of pelvic anatomic noble structures (art and nerves) is mandatory Under Fluoroscopic guidance A Kelekis JVIR 2005
21. Blastic?
22. Complications Leakage into the hip joint - to stop cement injection - to passively move the lower limb to shape the cement into the joint But a rapid chondrolysis after an intra-articular leak of bone cement LeclairA Gangi A Skeletal radiol. 2000 May Pulmonary embolism leakage into the pelvic veins (gluteal)
23. Results Pain Improvement in walking A. Cotten Radiology 1995 11 patients 9/11 pain relief , walking improved in each PY Marcy Support Care cancer 2000 18 patients Improvement in pain and walking 81,8% except 1 patient acetabular fracture Fracture long term follow up
24. G Anselmetti CVIR 2008 50 patients (19 pelvic bone) Pain was not improved in 6% of the patients
25. Woman 52 y uterine cancer acetabular metastasis treated with radiotherapy
26. Short procedure, few secondary effects : less pain and discomfort, reduced recovery time, short hospital stay-all, Acetabulum : Complete filling during multiple sessions ! ! ! To take care to ant. and post. Column