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目的探讨肿瘤型膝关节假体置换术治疗胫骨近端骨巨细胞瘤的临床效果。方法回顾性分析2000年6月至2014年2月,全国7个骨肿瘤治疗中心应用肿瘤型膝关节假体置换术治疗的76例胫骨近端骨巨细胞瘤患者,男32例,女44例;首诊时平均年龄(38±6.8)岁。原发49例中Campanacci Ⅱ级13例,Ⅲ级36例;复发27例中Campanacci Ⅱ级5例,Ⅲ级22例。根据肿瘤的范围,行胫骨近端肿瘤整块切除,采用旋转铰链型人工膝关节置换。均采用腓肠肌内侧头肌瓣转移覆盖假体,髌韧带止点与假体固定装置以及翻转的腓肠肌内侧头部分肌瓣缝合,重建伸膝装置。结果全部患者随访29~194个月,中位随访88个月。局部复发5例,浅表切口不愈合、坏死、积液8例,延迟深部感染11例,假体松动3例。假体5年存留率为84%,10年存留率为70%。术后1年MSTS评分平均24.2分,优良率67.1%。结论对于合并病理性骨折或Campanacci Ⅲ级的胫骨近端骨巨细胞瘤患者,采用整块切除旋转铰链型膝关节置换是有效的治疗方法,能较好地恢复膝关节功能,提高患者生活质量。
Objective To investigate the clinical effect of tumor type knee prosthesis replacement on giant cell tumor of proximal tibia. Methods A retrospective analysis of 76 patients with proximal giant-cell giant cell tumor of the tibia treated by tumor-type knee prosthesis in 7 bone tumor treatment centers in China from June 2000 to February 2014 was performed. There were 32 males and 44 females ; The average age at first consultation (38 ± 6.8) years. Of the 49 primary cases, 13 were Campanacci grade II and 36 were grade III; 5 were Campanacci grade II and 22 were grade III in 27 patients. According to the tumor range, the proximal tibial tumor resection, the use of rotary-type artificial knee joint replacement. The medial head gastrocnemius muscle flap was used to cover the prosthesis, the patellar ligament only point and the prosthesis fixation device and the inverted medial part of the gastrocnemius muscle flap were sutured, and the knee extensor device was reconstructed. Results All patients were followed up for 29 to 194 months, with a median follow-up of 88 months. Local recurrence in 5 cases, superficial incision nonunion, necrosis, effusion in 8 cases, delayed deep infection in 11 cases, prosthesis loose in 3 cases. Prosthesis 5-year survival rate of 84%, 10-year survival rate of 70%. The average score of MSTS was 24.2 at 1 year after operation, and the excellent and good rate was 67.1%. Conclusions For patients with giant cell tumor of proximal tibia with pathologic fracture or Campanacci grade Ⅲ, it is an effective method to treat knee osteoarthritis with knee joint replacement. It can restore the function of knee joint and improve the quality of life of patients.