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目的评估骨肿瘤初次保肢手术后生物性重建失败的肿瘤假体翻修的疗效。方法2004至2006年,13例骨肉瘤和3例骨巨细胞瘤患者在香港威尔斯亲王医院接受手术治疗。15例患者应用同种异体骨重建,另1例患者应用带血管腓骨移植重建骨缺损。应用肿瘤型假体进行翻修手术的重建。翻修术后患者膝关节活动范围良好时,订制的可延长假体接受延长手术。结果患者平均年龄23.2岁(13～43岁),平均随诊26.4个月(6～47个月)。翻修手术的原因包括:7例患者出现同种异体骨骨折或软骨下骨塌陷,5例患者骨不愈合,3例患者异体骨感染,1例患者膝关节僵硬。翻修手术的假体包括10例患者应用订制型假体,其他患者应用组合式假体。翻修手术的部位包括9例股骨远端假体,6例胫骨近端假体和1例股骨中段假体。订制假体中6例是可延长假体,假体的延长方式中5例是微创延长、1例无创延长。翻修手术后,膝关节活动改善,平均从18.1°(0°～90°)至91.9°(50°～120°)。下肢缩短不等长畸形从平均5cm(2～11.5cm)纠正至平均1.5cm(0～4cm)。翻修术后患肢功能MSTS评分从34.6%改善到89.2%。翻修术后2例患者出现部分皮肤坏死,1例患者出现腓总神经麻痹,以后部分恢复,1例患者出现胫骨裂纹骨折;没有感染和植入物失败。结论保肢手术后生物学重建失败所引起下肢缩短和僵硬,应用人工假体翻修是可行的,早期效果令人鼓舞。膝关节僵硬患者可获得良好的关节活动度。严重的下肢缩短畸形通过可伸长假体逐渐获得纠正。
Objective To evaluate the curative effect of revision of tumor prosthesis failed to reconstruct biological after initial limb salvage surgery. Methods From 2004 to 2006, 13 patients with osteosarcoma and 3 patients with giant cell tumor of bone were surgically treated at Prince of Wales Hospital in Hong Kong. Fifteen patients underwent allogeneic bone reconstruction, and the other one received reconstructed bone defects using a fibula graft. Reconstruction of revision surgery using oncology prosthesis. When the patient’s range of knee joint activity is good, the customized extended prosthesis is undergoing extended surgery. Results The average age of patients was 23.2 years (range, 13-43 years). The average follow-up time was 26.4 months (range 6-47 months). Reasons for revision surgery included allogeneic or subchondral bone collapse in 7 patients, nonunion in 5 patients, allograft infection in 3 patients, and knee stiffness in 1 patient. Revisions to revision surgery included the use of custom-made prostheses in 10 patients and the use of modular prostheses in other patients. The site of revision surgery included 9 cases of distal femur, 6 cases of proximal tibia and 1 case of mid-femur. Six of the customized prostheses were extendable prostheses. Five of them were minimally invasive and one was noninvasive. After revision surgery, knee activity improved, averaging from 18.1 ° (0 ° to 90 °) to 91.9 ° (50 ° to 120 °). Lower limb shortened unequal length of deformity from an average of 5cm (2 ~ 11.5cm) corrected to an average of 1.5cm (0 ~ 4cm). The MSTS score improved from 34.6% to 89.2% after revision surgery. Two patients had partial dermal necrosis after revision surgery, one had peroneal common nerve paralysis, partially recovered, and one patient had a tibial fracture; there was no infection or implant failure. Conclusions Shortening and stiffness of lower extremities caused by the failure of biological reconstruction after limb salvage surgery are feasible. The application of artificial prosthesis is feasible and the early results are encouraging. Patients with knee stiffness have good joint mobility. Severe lower extremity shortening deformities are gradually corrected by extensible prostheses.