骨干假体治疗股骨干转移性病理骨折的临床疗效  

Effectiveness of modular intercalary endoprosthesis for femoral metastatic pathological fracture

作　　者：王丰[1] 杨雄刚 刘永恒[1] 伦登兴[2] 张浩[1] 杨立[1] 赵立明[1] 张慧林[1] 苗军[3] 胡永成[3] Wang Feng;Yang Xionggang;Liu Yongheng;Lun Dengxing;Zhang Hao;Yang Li;Zhao Liming;Zhang Huilin;Miao Jun;Hu Yongcheng(Tianjin Medical University, Tianjin 300070, China;Department of Orthopedics,Weifang People's Hospital,Weifang261000,China;Department of Bone Oncology,Tianjin Hospital,Tianjin 300211,China)

机构地区：[1]天津医科大学,300070 [2]山东省潍坊市人民医院骨科,261000 [3]天津医院骨肿瘤科,300211

出　　处：《中华老年骨科与康复电子杂志》2017年第4期197-204,共8页Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)

基　　金：天津市卫生局课题(15KG124)

摘　　要：目的探讨股骨干转移瘤病理性骨折切除后骨干缺损进行骨干假体重建的临床疗效。方法回顾性分析天津医院骨肿瘤科2011年7月至2016年3月采用骨干瘤段切除假体置换手术治疗的股骨干转移病理性骨折患者15例,其中男性6例,女性9例,年龄57~81岁,平均年龄(68±9)岁。记录患者的手术时间、术中出血量及截骨长度,对其预期生存时间及实际生存时间进行评估与对比,并依据国际骨与软组织肿瘤协会(MSTS)标准进行评分。结果手术用时70(30)min;出血量800(200)ml;术中平均截骨长度(9.5±2.4)cm,范围:7~16 cm。病理回报:结肠癌转移1例,肺癌转移5例,乳腺癌转移3例,肾癌转移3例,肝癌转移2例,未知来源腺癌转移1例。随访2~25个月,中位随访时间7(6)个月,其中14例患者死亡,1例患者仍存活。死亡患者中位生存时间为6.5(5)个月。实际生存时间大于预期生存时间且差异有显著统计学意义(Z=-2.935,P<0.01)。末次随访时,15例患者患肢功能良好,均无局部复发及假体松动,MSTS术后评分平均为(26.0±1.8)分,范围:22~30分。结论肿瘤瘤段切除骨干假体重建术是治疗股骨干转移病理性骨折的有效术式之一,该术式能够达到安全的外科边界,降低局部复发率,并保留良好的肢体功能。Objective To explore the clinical effect of group-matched bone prosthesis in the treatment of femoral metastatic pathological fracture and reconstruction of bone defect.Methods Fifteen patients with metastatic carcinoma of femur treated surgically in department of bone oncology,Tianjin Hospital from July2011to March2016were retrospectively analyzed,including6males and9females with an average age of68±9years(57to81).Operation time,intraoperative blood loss and osteotomy length were recorded.The expecting and actual life span was estimated and compared.Results The median operation time was70(30)min.The median blood loss was800(200)ml.The mean osteotomy length was9.5±2.4cm(7to16).The median follow-up was7(6)months.Fourteen patients deceased and one patient was alive in the last follow up.The median survival was6.5(5)months for patients deceased.The actual survival time was longer than the expecting survival time by the Dutch model scoring system and difference was significant statistically(Z=-2.935,P<0.05).At the latest follow-up,all patients obtained fine limb function.The mean MSTS score was26.0±1.8(22to30).No patient had local relapse and prosthesis loosening.Conclusion Modular intercalary endoprosthesis is an effective treatment for segmental defects of femoral metastatic pathological fracture which can achieve safe surgical margins,reduce local recurrence rate and reserve limb function.

关 键 词：骨肿瘤 骨重建 假体植入 

分 类 号：R687.3[医药卫生—骨科学]