新型非骨水泥柄设计特征及临床应用效果  

Design Features and Clinical Result of a New Cementless Femoral Stem

作　　者：袁玉林[1] 王臻[1] 张浩强[1] 高鹏[1] 高天[1] 陈国景[1] 

机构地区：[1]第四军医大学西京医院骨肿瘤科,陕西西安710032

出　　处：《现代生物医学进展》2016年第18期3464-3468,3518,共6页Progress in Modern Biomedicine

基　　金：国家自然科学基金面上项目(31370944;31170914)

摘　　要：目的：探讨一种新型的适合于儿童的非骨水泥固定型股骨柄设计特征,并通过随访获得其临床效果。方法：选取2010年9月-2013年4月在我科植入新型非骨水泥股骨柄的6名儿童患者,其中男1例,女5例;年龄8.5±3.2岁（5-11岁）。病理诊断结果骨肉瘤患者5例,恶性神经鞘瘤患者1例;右股骨下端患者5例,左股骨下端患者1例;其中一例患者术前有病理骨折。6例患者在我科行双动半膝关节置换术,其中股骨下端均采用了新型非骨水泥假体柄。采用Enneking骨肌肉肿瘤置换后下肢功能评定标准对患肢行功能评价,影像学重点评估股骨柄在髓腔放置位置是否得当、股骨柄假体有无松动、有无应力遮挡、骨溶解等现象,并测量术后患者患肢短缩畸形数据。结果：6例患者随访时间32个月（14-54个月）,除1例5岁女童术前肢体条件较差在术后14个月行膝关节融合手术,其余无翻修病例,置换关节均无感染、折断等现象。MSTS评分21.33分;射线片示所有患者股骨髓腔内假体柄放置位置满意,股骨侧及胫腓骨侧假体周围未见骨溶解。结论：新型非骨水泥固定型股骨柄设计合理,早期稳定性可,后期可取得满意的生物固定效果。Objective： To explore the design characteristics of cementless fixed femoral components for children and their influence on clinical effects. Methods： 6 children（1 male and 5 female） who underwent double acting and half knee joint operation at our department were followed up from the September 2010 to April 2013. The average age is 8.5±3.2 years（range from 5 to 11 years old）. 5patients suffer from osteosarcoma. 1 patient suffers from malignant schwannoma. 5 cases were at the right lower end of the femur while 1cases at the lower end of the left femur. One case had pathological fracture before surgery. We used cementless fixed femoral components as distal femoral prosthesis to perform the double acting and a half knee arthroplasty. Functional evaluation of the affected limb was evaluated by using Enneking evaluation standard to evaluate the injured limbs. Radiographic was used to evaluate the filling rate of marrow cavity, the shift of femoral components prosthesis, the periprosthetic radioactive bright line, stress shielding and osteolysis. We also measured the data of limb shortening deformity with postoperative patients. Results： 6 patients were followed up for 32 months（range from 14 to 54 months） except for one 5 year old girl with bad limb conditions preoperative who took knee joint fusion operation in14 months after surgery. In the rest of the cases, there were no infection and fracture in replaced joints. MSTS score was 21.33 points.Postoperative X-ray showed that all patients had a satisfactory femoral filling rate of marrow cavity in both planes and no osteolysis was found around all the prosthesis. Conclusion： The new type of cementless fixed femoral components for children with double acting and artificial half knee joint prosthesis was suitable for biological fixation. It can achieve satisfactory clinical outcomes with good initial stability, rapid bone ingrowth and low stress shielding.

关 键 词：骨肿瘤 儿童肿瘤型假体 非骨水泥股骨假体柄 随访研究 

分 类 号：R738[医药卫生—肿瘤] R318.08[医药卫生—临床医学]