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[目的]比较应用可旋转稳定型人工膝关节假体与单纯铰链型假体治疗胫骨近端恶性骨肿瘤的临床疗效。[方法]回顾性分析2009年6月~2012年10月间在本院行可旋转稳定型膝关节假体(A组)和单纯铰链型假体(B组)治疗的胫骨近端恶性骨肿瘤患者的临床资料。A组:男10例,女7例,平均年龄26.5岁,其中骨肉瘤7例,软骨肉瘤5例,侵袭性骨巨细胞瘤4例,恶性纤维组织细胞瘤1例;B组:男16例,女5例,平均年龄28岁,其中骨肉瘤11例,软骨肉瘤4例,侵袭性骨巨细胞瘤3例,纤维肉瘤3例。手术对胫骨近端肿瘤进行广泛切除或根治性切除后,采用假体重建膝关节;对化疗敏感的病例同时采用新辅助化疗治疗。置换后采用Enneking膝关节评分标准对膝关节功能进行评估,并记录膝关节屈伸度数。[结果]A组随访7~48个月(平均28个月),5例出现复发,Enneking下肢功能评估优11例(64.7%),良5例(29.4%),差1例(5.9%),优良率达94.1%;膝关节伸直0°,屈曲(131.5±17.8)°。B组随访8~45个月(平均25个月),4例出现复发,Enneking下肢功能评估优11例(52.4%),良8例(38.1%),差2例(9.5%),优良率达90.5%;膝关节伸直0°,屈曲(116.5±15.4)°。组间比较,膝关节术后Enneking功能评估优良率差异无显著性(P>0.05),而膝关节屈曲度数可旋转稳定假体组较大,差异有显著性意义(P<0.05)。[结论]采用可旋转稳定型膝关节置换治疗胫骨近端恶性骨肿瘤是有效的保肢方法,可获得较单纯铰链型假体更大的膝关节活动度。
[Objective] To compare the clinical curative effect of treatment of proximal tibia malignant bone tumor by rotating stable artificial knee prosthesis and simple hinge prosthesis. [Methods] The clinical data of proximal tibial malignant bone tumors (A group) and simple hinge prosthesis (B group) treated in our hospital from June 2009 to October 2012 were retrospectively analyzed. The patient’s clinical data. Group A: 10 males and 7 females, with an average age of 26.5 years, including 7 osteosarcoma, 5 chondrosarcoma, 4 invasive giant cell tumor and 1 malignant fibrous histiocytoma. Group B: 16 males , 5 females with an average age of 28 years, of which osteosarcoma in 11 cases, chondrosarcoma in 4 cases, invasive giant cell tumor in 3 cases, fibrosarcoma in 3 cases. After extensive resection or radical resection of the proximal tibial tumor by surgery, the prosthesis was used to reconstruct the knee joint. Chemotherapy-sensitive cases were treated with neoadjuvant chemotherapy. After replacement, the knee joint function was evaluated by Enneking knee score and the degree of knee flexion and extension was recorded. [Results] In group A, follow-up was performed for 7 to 48 months (average 28 months), and 5 cases showed recurrence. Enneking leg function assessment was excellent in 11 cases (64.7%), good in 5 cases (29.4% The excellent and good rate was 94.1%. The knee joint was straight at 0 ° and flexed at 131.5 ± 17.8 °. In group B, patients in group B were followed up for 8 to 45 months (average 25 months), and 4 patients relapsed. Enneking leg function assessment was excellent in 11 cases (52.4%), good in 8 cases (38.1%) and poor in 2 cases (9.5% Up to 90.5%; knee extension 0 °, flexion (116.5 ± 15.4) °. There was no significant difference between the two groups in the evaluation of Enneking function (P> 0.05). However, the flexural stability of the knee joint was larger in the stable rotation group, with significant difference (P <0.05). [Conclusion] It is an effective limb salvage method to treat the proximal tibial malignant bone tumor by rotating and stable type of knee joint replacement. The knee joint mobility can be obtained more than simple hinge type prosthesis.