论文部分内容阅读
目的探讨定制型人工关节在下肢近关节处肿瘤保肢术中的应用可行性。方法回顾分析我院2002～2007年接受定制型人工关节置换进行保肢治疗的下肢近关节处肿瘤患者46例,其中髋臼处肿瘤8例,股骨上段7例,股骨下段14例,胫腓骨上段17例。其中骨巨细胞瘤7例(复发性骨巨细胞瘤5例,骨折2例),骨巨细胞瘤合并动脉瘤样骨囊肿1例,骨母细胞瘤1例;恶性肿瘤37例,分别是成骨性骨肉瘤18例,转移性肿瘤6例(骨折2例),软骨肉瘤9例,恶性纤维组织细胞瘤3例(骨折1例),纤维肉瘤1例。所有患者均使用国产定制型假体。术前化疗1～2个疗程。结果术后46例中41例获12～65个月随访。术后3例皮下积液,2例局部皮肤坏死行皮瓣转位后治愈;1例外伤后股骨上段假体折断,行翻修术后可行走。2例术后分别于17、24个月局部复发行截肢术。术后肺转移6例,脑转移4例,恶性肿瘤最终保肢率91.6%。参照Enneking骨骼肌肉肿瘤术后肢体功能评定标准,优15例,良19例,可4例,差3例。术后2年生存率85.3%(35/41),3年生存率73.1%(30/41),5年生存率58.6%(24/41)。2年局部无复发87%,3年为73.5%,5年为64.7%。结论辅以围手术期综合治疗,人工假体置换术是下肢近关节恶性骨肿瘤解除疼痛、保肢、重建功能的一种有效方法。
Objective To investigate the feasibility of custom-made artificial joints in the limb salvage surgery of lower extremity near joints. Methods A retrospective analysis of our hospital from 2002 to 2007 undergoing limb salvage with customized artificial joint replacement limb cancer in 46 patients, including acetabulum tumor in 8 cases, 7 cases of upper femur, 14 cases of the lower femur, upper tibia and fibula 17 cases. Among them were 7 cases of giant cell tumor of bone (5 cases of recurrent giant cell tumor of bone and 2 cases of fracture), 1 case of giant cell tumor of bone with aneurysmal bone cyst, 1 case of osteoblastoma, and 37 cases of malignant tumor 18 cases of osteosarcoma, 6 cases of metastatic tumor (2 cases of fracture), 9 cases of chondrosarcoma, 3 cases of malignant fibrous histiocytoma (1 case of fracture) and 1 case of fibrosarcoma. All patients using domestic custom prosthesis. Preoperative chemotherapy 1 to 2 courses. Results Of the 46 cases, 41 cases were followed up for 12 to 65 months. Three cases were subcutaneously infiltrated and two cases of local skin necrosis were transplanted. After the traumatic injury, the upper femoral prosthesis was broken and could be operated after revision. Two patients underwent local amputation in 17 and 24 months respectively. Postoperative lung metastases in 6 cases, brain metastases in 4 cases, the final salvage rate of malignant tumors 91.6%. According to Enneking skeletal muscle tumor postoperative limb function evaluation criteria, excellent in 15 cases, good in 19 cases, 4 cases, poor in 3 cases. The 2-year survival rate was 85.3% (35/41), 3-year survival rate was 73.1% (30/41), and 5-year survival rate was 58.6% (24/41). No local recurrence in 2 years 87%, 73.5% in 3 years, 64.7% in 5 years. Conclusions Combined with perioperative comprehensive treatment, artificial prosthesis replacement is an effective method to relieve pain, limb salvage and reconstruction of the lower extremity near-joint malignant bone tumor.