特制人工膝关节置换治疗儿童股骨远端ⅡB期经典型骨肉瘤  

Special prosthesis for the treatment of stage ⅡB conventional osteosarcoma in the distal femur in children

作　　者：李远[1] 徐海荣[1] 黄真[1] 单华超[1] 牛晓辉[1] Li Yuan;Xu Hairong;Huang Zhen;Shan Huachao;Niu Xiaohui(Department of Orthopedic Oncology ,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院骨肿瘤科

出　　处：《骨科临床与研究杂志》2019年第5期274-280,共7页Journal Of Clinical Orthopedics And Research

摘　　要：目的评估股骨远端ⅡB期经典骨肉瘤患儿接受特制人工关节置换手术后生存率、假体生存率、假体失败因素及功能。方法回顾研究2005年1月至2012年12月北京积水潭医院骨肿瘤科连续收治的接受特制人工膝关节置换治疗的股骨远端ⅡB期经典骨肉瘤患儿39例,男17例,女22例,平均年龄10.9(6~14)岁。记录患者性别、年龄、化疗情况、手术日期、假体并发症、假体生存率、术后功能评分等。通过Kaplan-Meier生存曲线分析生存率。结果34例患者进行了广泛切除,5例患者进行了边缘切除。切除的股骨长度平均172(110~240)mm。39例患者中位随访时间66(10~141)个月。无瘤生存28例,带瘤生存3例,病死8例。Kaplan-Meier生存分析结果显示,患儿5年生存率78.1%。随访期内无局部复发病例。以截肢或假体取出为终点,39例患者假体3年生存率97.2%,5年生存率84.9%,随访期末31例存活患者中84%(26/31)假体生存。随访期末28例保肢成功,保肢率90.3%(28/31)。随访期内共16例患者发生18次假体并发症,导致2例行翻修手术更换假体及3例截肢。最常见的并发症为无菌性松动(14例),影响假体生存的原因为:软组织失败、无菌性松动、假体结构失败、感染、不能接受肢体不等长(各1例)。25例患者评估下肢长度,评估时间距手术平均62(18~120)个月。患侧下肢长度短于健侧平均70(20~144)mm。最终保肢成功28例患者术后国际骨与软组织肿瘤协会(MSTS)评分平均24(21~26)分。结论经过规范术前化疗,肿瘤切除加特制人工关节置换手术,术后化疗,肿瘤学预后良好。特制人工关节置换术后,假体生存率及功能结果可接受。假体无菌性松动发生率较高。Objective To evaluate the survival rate, prosthesis survival rate, prognostic factors associated with prosthesis failure and functional score for patients with stage ⅡB conventional osteosarcoma in the distal femur and treated with special prosthesis replacement surgery. Methods From January 2005 to December 2012, a total of 39 consecutive cases of children with stage ⅡB conventional osteosarcoma in the distal femur who underwent special prosthesis treatment, including 17 males and 22 females with an average age of 10.9 (6-14) years, were retrospectively reviewed in Department of Orthopedic Oncology, Beijing Jishuitan Hospital. The patient's gender, age, chemotherapy status, date of surgery, prosthesis complications, prosthesis survival and postoperative functional outcomes were recorded. Survival rates were analyzed by Kaplan -Meier survival curves. Results Thirty-four patients underwent wide resection and 5 patients underwent marginal resection . The length of the resected femur was 172 (110-240) mm on average. The median follow-up time of 39 patients was 66 (10-141) months. Twenty-eighth patients survived without tumor.Three patients survived with tumor, and 8 patients were dead. Kaplan-Meier survival analysis showed a 5-year survival rate of 78.1%. There was no local recurrence case during the follow-up period. With amputation or prosthesis removal as the end point, the 3-year survival rate of the prosthesis was 97.2% in 39 patients, and the 5-year survival rate was 84.9%. At the end of the follow-up period, 84%(26/31) prosthesis of the 31 surviving patients survived . At the end of the follow-up period, 28 patients had successful limb salvage and the rate of limb salvage was 90.3%(28/31). A total of 16 patients had 18 prosthetic complications, resulting in 2 revision surgery replacements and 3 amputations during the follow-up period. The most common complication was aseptic loosening (14 cases), which affected the survival of the prosthesis: soft tissue failure, aseptic loosening, prosthetic structural f

关 键 词：股骨肿瘤 骨肉瘤 关节成形术 置换 膝 儿童 

分 类 号：R738.1[医药卫生—肿瘤]