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目的总结近年肿瘤型人工膝关节置换术的疗效及并发症。方法 1997年7月至2004年7月,对117例膝关节周围骨肉瘤患者实施广泛切除后人工关节置换术,其中男性66例,女性51例,年龄13～57岁;部位包括股骨远端65例,胫骨近端52例。19例患者使用灭活肿瘤骨结合人工假体复合重建缺损,25例患者使用了异体骨人工关节复合体。所有成骨肉瘤患者术前均行2个循环的规范化疗。结果所有患者均获随访,平均随访时间3.5年(1～8年)。发生并发症情况:5例患者假体柄折断(2例为进口假体,3例为国产假体);19例患者假体迟发性感染(17例为国产假体,2例为进口假体);3例患者出现假体松动;9例患者移植物与宿主骨接合处不愈合,由于内固定坚固,患者可以行走;2例患者出现了异体骨吸收;2例患者发生假体下沉;1例患者出现了骨折。肿瘤局部控制:7例患者在术后0.5～2.0年内局部复发,其中4例为软组织肿瘤复发,而后接受肿瘤再切除,另3例截肢。结论肿瘤型人工膝关节置换术可保留较好的膝关节功能,达到保肢术规定的局部复发率要求。但由于其仍存在较高并发症发生率,仍有待进一步改进。
Objective To summarize the curative effect and complications of tumor-type artificial knee arthroplasty in recent years. Methods From July 1997 to July 2004, a total of 117 patients with osteosarcoma around the knee were treated with extensive resection of the artificial joint, including 66 males and 51 females, aged from 13 to 57 years old. The sites included distal femur 65 For example, the proximal tibia 52 cases. Nineteen patients underwent reconstructive defect reconstruction with inactivated tumor and bone prosthesis, and 25 patients underwent allogeneic osteoarthritis. All osteosarcoma patients underwent 2 cycles of standard chemotherapy before surgery. Results All patients were followed up for an average of 3.5 years (range 1 to 8 years). Complications occurred: prosthesis slipping in 5 patients (2 imported prostheses and 3 domestic prostheses); delayed prosthesis infection in 19 patients (17 for domestic prosthesis and 2 for imported leave 3 patients had loosening of prosthesis; 9 patients did not heal at the junction of the graft and the host bone, because the internal fixation was firm, the patient could walk; 2 patients had allogeneic bone resorption; 2 patients had prosthesis sinking One patient had a fracture. Tumor Local Control: Seven patients recurred locally from 0.5 to 2.0 years after surgery, of which 4 were recurrences of soft tissue tumors, followed by resection of tumors and 3 other cases of amputation. Conclusion Tumor-type artificial knee arthroplasty can retain good knee function and meet the local recurrence rate requirements of limb salvage. However, due to its still high incidence of complications, remains to be further improved.