人工全股骨置换术治疗股骨恶性肿瘤  

Total femoral replacement for treating femur malignant tumor

作　　者：吴凡[1,2] 方向[1] 郎志刚 刘宏远 熊燕[1] 张闻力 罗翼[1] 屠重棋[1] 段宏[1] WU Fan;FANG Xiang;LANGZhigang;LIUHongyuan;XIONGYan;ZHANGWenli;LUOYi;TU Chongqi;DUAN Hong(Department of Orthopedics,West China Hospital,Sichuan University,Chengdu Sichuan,610041,P.R.China;Section I Department of Orthopedics,the Fourth People's Hospital of Zigong City,Zigong Sichuan,643000,P.R.China;Department of Osteopathy,Sichuan Provincial Orthopedic Hospital,Chengdu Sichuan,610041,P.R.China;Department of Orthopedics,Sichuan Provincial Fifth People's Hospital,Chengdu Sichuan,610031,P.R.China)

机构地区：[1]四川大学华西医院骨科,成都610041 [2]自贡市第四人民医院骨一科,四川自贡643000 [3]四川省骨科医院骨病科,成都610041 [4]四川省第五人民医院骨科,成都610031

出　　处：《中国修复重建外科杂志》2019年第1期18-22,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨人工全股骨置换术治疗股骨恶性肿瘤的手术方法和临床疗效。方法回顾分析2013年7月—2017年3月行人工全股骨置换术治疗的9例股骨肿瘤患者临床资料,其中男5例,女4例;年龄16～75岁,平均44.8岁。病程2～6个月,平均3.5个月。骨肉瘤5例(EnnekingⅡB期3例、Ⅲ期2例),恶性纤维肉瘤1例(EnnekingⅡB期),软骨肉瘤1例(EnnekingⅠB期),肺癌股骨多发转移伴病理性骨折2例。分别于术前及术后3个月采用疼痛视觉模拟评分(VAS)、肿瘤患者生活质量评分(QOL)评价其生活质量,末次随访时采用国际骨与软组织肿瘤协会(MSTS)评分和髋关节功能Harris评分(HHS)评价其功能。结果 9例患者均获随访,随访时间11～58个月,平均21个月。无伤口感染、关节脱位、神经损伤等并发症发生。1例患者发生腘静脉血栓形成,2例骨肉瘤患者肿瘤持续进展死亡。术后3个月VAS评分和QQL评分分别为(3.2±1.2)、(40.6±5.4)分,均较术前的(5.9±0.8)、(22.3±4.2)分显著改善(t=11.314,P=0.000;t=–7.794,P=0.000)。末次随访时MSTS评分为15～29分,平均21.1分;HHS评分为44～90分,平均66.5分。结论人工全股骨置换术是治疗股骨恶性肿瘤的有效保肢方案,能够恢复肢体的负重和行走功能,减轻疼痛和提高生活质量。Objective To investigate the procedure and effectiveness of total femoral replacement for treating femur malignant tumor. Methods The clinical data of 9 patients with femoral malignant tumors who underwent total femoral replacement between July 2013 and March 2017 were retrospectively analyzed. There were 5 males and 4 females, aged 16-75 years with an average of 44.8 years. The disease duration ranged from 2 to 6 months with an average of 3.5 months. There were 5 cases of osteosarcoma (3 cases were staged as Enneking ⅡB, 2 cases were staged as Enneking Ⅲ), 1 case of malignant fibrosarcoma (staged as Enneking ⅡB), 1 case of chondrosarcoma (staged as Enneking ⅠB), 2 cases of femoral muti-metastasis of lung cancer with pathological fracture. The visual analogue scale (VAS) score and the quality of life (QOL) score of the tumor patients were evaluated before operation and at 3 months after operation. The Musculoskeletal Tumor Society (MSTS) score and Harris hip score (HHS) were evaluated at last follow-up. Results Nine patients were followed up 11-58 months, with an average of 21 months. No complication such as wound infection, joint dislocation, and nerve injury occurred. One patient developed popliteal vein thrombosis, and 2 patients with osteosarcoma died of tumor progression. The VAS score and QOL score at 3 months after operation were 3.2±1.2 and 40.6±5.4 respectively, which were significantly improved when compared with preoperative ones (5.9±0.8 and 22.3±4.2 respectively) (t=11.314, P=0.000; t=–7.794, P=0.000). At last follow-up, the MSTS score was 15-29 with an average of 21.1, and the HHS score was 44-90 with an average of 66.5. Conclusion Total femoral replacement is an effective limb salvage procedure for the treatment of femoral malignant tumors, which can effectively restore the weight-bearing and walking function, relieve pain, and improve the quality of life.

关 键 词：全股骨置换术 股骨恶性肿瘤 保肢手术 

分 类 号：R738.1[医药卫生—肿瘤]