保留关节的瘤段切除酒精灭活再植术在膝关节周围恶性骨肿瘤治疗中的应用  

Surgical technique of alcohol-inactivated autograft replantation with articulation preservation in management of malignant bone tumor around knee

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

机构地区：[1]济南军区总医院骨病科,250031

出　　处：《中华关节外科杂志（电子版）》2012年第3期12-15,共4页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的探讨保留关节的酒精灭活骨再植术在膝关节周围恶性骨肿瘤治疗中的应用,并阐述其手术技术要点。方法 2010年1月至2011年5月采用保留关节的瘤段切除酒精灭活再植术治疗膝关节周围恶性骨肿瘤7例。年龄16～23岁,中位年龄21岁;男6例,女1例;左股骨下段5例,右股骨下段1例,左腓骨上段累及胫骨1例;Enneking分期Ⅱb期6例,Ⅲ期1例;骨肉瘤6例,非霍杰金氏淋巴瘤1例。术后疗效评价采用MSTS功能评分和ISOLS复合移植物影像评分。结合手术操作,阐述该手术的技术要点和注意事项。结果 7例患者术后切口均Ⅰ期愈合。随访8～24个月,平均随访17个月,无假体松动、脱位、肢体短缩。末次随访,ISOLS影像评分30～34分,平均31分(87%);MSTS肢体功能评分22～28分,平均25分(84%)。严格适应证,掌握手术技巧,注意围手术期处理,可以取得良好效果。结论保留关节的酒精灭活再植术,可以早期获得良好功能,避免人工假体置换的并发症,经济便宜,可以作为手术治疗的一种选择,其长期疗效和优缺点有待进一步随访研究。Objective To evaluate the clinical outcome of alcohol-inactivated autografi replantation with articulation preservation in management of malignant bone tumor around knee, and explain the surgical technique. Methods Seven patients were treated with alcohol-inactivated autograft replautation with articulation preservation from January 2010 to November 2011, including six males and one female, with the median age of 21 years （16 to 23 years）. Five neoplasms were located in left distal femur, one in right distal femur, and one in left proxinlal fibula involving tibia. According to Enneking tumor staging, six patients were identified as stage liB, one as stage III. Six patients were diagnosed as osteosarcoma and one as non-Hodgkin＇ s lymphoma. The postoperative results were evaluated by MSTS limb function score system and ISOLS composite graft evaluation method. Combining the operation process, surgical technique and perioperative key points were explained. Results All seven patients achieved primary healing. With the mean follow-up time of 17 months （8 to 24 months ）, there was no infection, recm＇rence, loosening or limb length inequality. The mean ISOLS graft score was 31 （87%） （range 30 - 34）. The mean MSTS function score was 25 （84%） （range 22 -25 ）. Conclusions These results suggest that alcohol-inactivated autograft replantation with articulation preservation could improve the short- term limb function, avoiding complications of prosthesis. With strict indications, good surgical technique and perioperative managements, fine clinical outcome could be achieved. It is relatively economicapplicable for patients and could be an option among surgical treatments. The clinical outcomes in long- term still need to be investigated.

关 键 词：骨肿瘤 关节 乙醇 再植术 功能 

分 类 号：R738.1[医药卫生—肿瘤]