股骨中心型软骨肉瘤根切定制全股骨假体置换保肢术随访七年一例报告  

Customized total femur prosthesis replacement for limb salvage after radical resection of central chondrosarcoma of the femur:1 case report with 7-years follow-up

作　　者：冯德宏[1] 王凌[1] 丁育健 郭宇[1] FENG De-hong;WANG Ling;DING Yu-jian;GUO Yu(Department of Joint Surgery,Wuxi People＇s Hospital affiliated to Nanjing Medical University,Wuxi,Jiangsu,214043,China)

机构地区：[1]南京医科大学附属无锡市人民医院关节外科,江苏214043

出　　处：《中国骨与关节杂志》2018年第11期878-880,共3页Chinese Journal of Bone and Joint

摘　　要：全股骨置换治疗股骨恶性肿瘤国内报道不多，国外Friesecke等^[1]曾报道全股骨假体植入手术100例，其中用于股骨恶性肿瘤切除后置换仅4例，且均为转移性肿瘤。笔者于2011年6月收治1例股骨中心型高分化软骨肉瘤，随访7年无临床复发和转移征象，现报道如下。Objective To report 7 years＇ follow-up results of radical resection and limb salvage of femoral central chondrosarcoma with total femoral replacement in 1 case. Methods A 44-year-old female patient with femoral central chondrosarcoma was admitted. X-ray and MRI demonstrated the erosive destruction in the middle and distal right femur. And the medullary cavity of the proximal femur was also involved. The well-differentiated chondrosarcoma was confirmed by biopsy and Ennecking classification was IB. Right total femoral radical resection and customized femoral prosthesis replacement was performed under general anesthesia in July 2011. During the surgery, muscles stopping on the great trochanter were preserved and reconstructed, while the end point of gluteus maximus was also repaired. Results The surgery lasted 3.5 h. The intraoperative bleeding was 500 ml, and the total transfusion was 1200 ml. The incision healed without wound rupture or infection. The right femoral chondrosarcoma （ G1 ） was confirmed by postoperative pathology. The follow-up results of X-ray showed that the position of implantation was ideal. The alignment of the lower extremity was good. No infection, prosthetic dislocation or loosening occurred. The MSTS93 scores were 18 points at 8 months and 25 points at 84 months after surgery respectively. The percentage of function was 83.3%, and the effect was excellent. Conclusions Total femoral replacement can be an alternative method for limb salvage in the case of total femoral malignant tumor. The reconstruction ofgluteus medius and the repair of the deltoid muscle of the hip in the operation can preserve the stability and the function of hip abduction. The calcification shadow around the prosthesis indicates that parts of the femoral muscles are reimmobilized in situ. The gradual improvement of the gait also suggests that the function of the hip abductor could be restored to a great extent later.

关 键 词：股骨 软骨肉瘤 假体 

分 类 号：R738.3[医药卫生—肿瘤] R687.3[医药卫生—临床医学]