酒精灭活骨复合人工假体治疗股骨远端骨巨细胞瘤及有限元分析  

Clinical and finite element analysis of alcohol-deactivated autograft-prosthesis composite after resection of bone giant cell tumor in distal femur

作　　者：许宋锋[1] 杨阳[1] 徐明[1] 于秀淳[1] 

机构地区：[1]济南军区总医院骨病科,250031

出　　处：《中华骨科杂志》2011年第6期611-616,共6页Chinese Journal of Orthopaedics

摘　　要：目的探讨酒精灭活骨复合人工假体治疗股骨远端骨巨细胞瘤的临床疗效。方法2007年1月至2008年10月应用酒精灭活骨复合旋转铰链膝关节治疗股骨远端骨巨细胞瘤5例，男3例、女2例；年龄22-40岁，平均29．6岁。3例为术后复发病例，2例伴病理性骨折。均为Campanaccim级。选择1名18岁成年男性健康志愿者，利用CT数据建立股骨远端40％骨缺损的复合假体三维有限元模型，加载平地慢速行走步态周期下肢3倍重量负荷，分析股骨-骨水泥-假体柄的应力分布。结果全部5例随访28-49个月，平均37个月。无感染、肿瘤复发、假体松动、肢体短缩等并发症。术后6-11个月骨性愈合。1993年美国骨肿瘤学会（Musculoskeletal Tomor Society，MSTS）功能评分25-27分，平均25．7分（85．7％）；ISOLS影像评分28-35分，平均31．4分（87．2％）。有限元分析表明，早期最大应力分别出现在股骨近段（145．82MPa）、骨水泥上1／4段内侧（40．90MPa）及假体柄上段（389．24MPa），均未超过三种材料的最大应力负荷；远期愈合后股骨、骨水泥及假体柄应力降低至139．05MPa、36．95MPa、253．65MPa。结论酒精灭活骨复合旋转铰链膝关节治疗股骨远端骨巨细胞瘤，术后肿瘤复发率低、早期肢体功能好。有限元结果提示术后早期力学稳定性好，远期应力遮挡小。Objective To evaluate the clinical outcome of alcohol-deactivated autograft-prosthesis composite after resection of bone giant cell tumor in distal femur. Methods From January 2007 to October 2008, 5 patients with bone giant cell tumor in distal femur were treated with alcohol-deactivated autograftprosthesis composite, including 3 males and 2 females with an average age of 29.6 years （range, 22-40）. Three patients were diagnosed with postoperative recurrence, and 2 with pathological fracture. All patients were of Campanacci m. Three-dimensional finite element models with 40% bone defect in distal femur were established based on CT images of a healthy volunteer. Three times of body mass load corresponding to the normal walking gait cycle was applied. The influence on stress distribution of femur-cement and prosthesis stem was analyzed. Results All patients were followed up for average 37 months, there was no infection, recurrence, loosening and limb length inequality. The bony healing time was 6 to 11 months. The mean MSTS function score was 25.7 （range, 25-27）. The mean ISOLS graft score was 31.4 （range, 28-35）. The finite element analysis showed that for the short-term model, the maximum stress was 145.82 MPa in the proximal femur, 40.90 MPa in the medial side of 1/4 proximal cement, and 389.24 MPa in the proximal prosthesis stem. The maximum stress was not exceeding the fatigue strength in three sites. For the long-term model, with the bone healing, the maximum stress on three sites decreased to 139.05, 36.95, and 253.65 MPa, respectively. Conclusion These results suggest that the alcohol-deactivated autograft-prosthesis composite after resection of bone giant cell tumor in distal femur can reduce the tumor recurrence and improve the short-term limb function, It is stable in short term and can reduae stress shielding in. long term.

关 键 词：巨细胞瘤 骨 股骨 膝关节 人工 有限元分析 

分 类 号：R738[医药卫生—肿瘤]