肿瘤型假体治疗膝关节周围骨巨细胞瘤的远期疗效  

Long-term outcomes of giant cell tumors around knee treated with en bloc resection and reconstruction with massive end-oprosthesis

作　　者：于秀淳[1] 徐明[1] 宋若先[1] 付志厚[1] 刘晓平[1] 

机构地区：[1]济南军区总医院骨病科,山东济南250031

出　　处：《生物骨科材料与临床研究》2010年第2期20-24,共5页Orthopaedic Biomechanics Materials and Clinical Study

摘　　要：目的总结肿瘤型膝关节假体置换术治疗膝关节周围骨巨细胞瘤的远期临床疗效和并发症。方法回顾分析我院自1991年1月始随访超过5年以上的19例患者。男11例,女8例,平均年龄35.4岁。股骨远端12例,胫骨近端7例。原发9例,术后复发10例,合并病理骨折4例。X线分期均为Campanacci Ⅲ级,均采用国产肿瘤型膝关节假体,其中旋转铰链膝关节4例,铰链膝关节15例。结果本组患者无术中及近期手术并发症发生。平均随访128.9月(60～216月),除1例患者因术后切口感染于翻修术后2年行截肢术外,18例患者术后肢体功能评分15～27分,平均22.7分(75.6%)。双侧肢体等长者9例,患肢较健侧短2cm以内者3例,3～5cm3例,5～9cm3例。假体断裂并假体松动1例,假体无菌性松动3例,迟发性深部感染并假体松动2例。假体松动率为31.6%。假体近端骨折1例。6例假体松动患者均行肿瘤型假体翻修术,除1例截肢患者外,余5例随访36～72月,肢体功能评分平均为23.8。合并假体近端骨折的患者行切开复位植骨内固定术,现已术后24月,肢体功能评分27分。结论肿瘤型假体置换术是治疗骨巨细胞瘤一种可行的治疗方法。随着患者生存期的不断延长,与假体相关的并发症会逐渐增加,肿瘤假体松动和肢体短缩是主要的远期并发症,也是影响其远期疗效的主要因素。Objective To study the long-term outcomes and complications of giant cell tumors around knee treated with en bloc resection and reconstruction with massive endoprosthesis. Methods Among 19 patients, treated in our hospital from January 1991 and the follow-up time more than 5 years, there were 11 males and 8 females with the average age of 35.4 years. The distal femurs were involved in 12 cases, the proximal tibia in 7 cases. 9 cases were of primary, 10 cases were of recurrent, 4 patients with pathological fracture. All were of Campanacci Ⅲ grade.19 patients were treated with en bloc resection of tumor and reconstruction with domestic massive endoprosthesis, including 15 patients with hinge knee prostheses, and 4 patients with rotating-hinge knee prostheses. Results No intraoperative and postoperative complications developed. The mean follow-up was 128.9 months （60-216 months）. Except one patient underwent amputation because of postoperative wound infection after reoperation two years, the mean functional score of affected limb in 18 patients was 22.7 （15 to 27 points）. The length of both lower extremity equaled in 9 cases, the length of affected limb was shorter 2cm than that of the control in 3 cases,3-5cm in 3 cases and 5-9cm in 3 cases. Prosthesis fracture and loosening developed in 1 case, prosthesis aseptic loosening in 3 cases, delayed deep infection and prosthesis loosening in 2 cases. Prosthesis loosening rate in the group was 31.6%. Proximal femur fracture developed in 1 case. The six patients underwent tumor prosthesis revision operation, 5 patients were followed-up 36-72 months except one was performed amputation, the mean function scores of affected limb were 23.8. The patient with proximal femur fracture underwent open reduction and bone grafting with internal fixation. During follow-up of 24 months, the bone healed well, limb function score was 27 points. Conclusion The en bloc resection of tumor and recon- struction with massive endoprosthesis is a feasible method to treat giant cell tumo

关 键 词：骨巨细胞瘤 膝关节 肿瘤性假体 远期疗效 

分 类 号：R738.1[医药卫生—肿瘤]