肿瘤膝关节假体与大段同种异体骨重建治疗膝关节周围肿瘤疗效对比  

A Comparative Study on the Therapeutic Effect of Tumor Knee Prosthesis and Large Segment Allogeneic Bone Reconstruction in the Treatment of Tumor Around Knee Joint

作　　者：王振[1] 刘继军 Wang Zhen;Liu Jijun(Department of Orthopaedics,Henan University People’s Hospital,Zhengzhou450000,China)

机构地区：[1]河南大学人民医院骨科

出　　处：《实用骨科杂志》2019年第11期978-981,共4页Journal of Practical Orthopaedics

摘　　要：目的探讨肿瘤型膝关节假体与大段同种异体骨复合带血管腓骨重建治疗膝关节周围肿瘤的手术适应证、临床疗效及并发症。方法回顾性分析2010年6月至2015年6月,在我中心行保肢手术并获得随访的膝关节周围肿瘤患者共51例,其中男28例,女23例;年龄7~61岁,平均(17.8±1.2)岁。骨肉瘤37例,尤文肉瘤12例,骨巨细胞术后复发1例,软骨肉瘤Ⅱ级1例。累及股骨远端31例,胫骨近端20例。接受肿瘤型膝关节假体置换33例,病变位于股骨20例,胫骨13例;接受大段异体骨复合带血管腓骨重建18例,病变位于股骨11例,胫骨7例。结果本组51例患者均获随访,随访时间47~71个月,平均(58.0±3.0)个月。14例(27.5%)死亡,23例(45.1%)术后出现了肺转移,3例(5.9%)局部复发,6例(11.8%)出现术后感染,5例(9.8%)无瘤存活。用美国骨骼肌肉系统肿瘤协会评分(mus-culoskeletal tumor society,MSTS),肿瘤型膝关节假体置换患者平均(24.5±2.1)分,异体骨复合带血管腓骨重建患者平均(26.1±1.7)分。结论保肢手术已经成为治疗膝关节周围恶性肿瘤的主要方式,肿瘤型膝关节假体是主要的重建方式,具有负重早、稳定性好、早期并发症低等优点。大段异体骨复合带血管腓骨重建,对于病变未明显累及骨骺,预期生存时间较长的患者具有一定的优势,但术后并发症较多,必须严格掌握适应证。Objective To explore the surgical indications,clinical effects and complications of tumor type knee joint prosthesis combined with large segment allograft and vascularized fibula reconstruction in the treatment of periarticular tumors of the knee joint.Methods From June 2010 to June 2015,51 cases of periarticular tumor in our center were analyzed retrospectively,including 28 males and 23 females,aged 7~61 years with an average of(17.8±1.2)years.There were 37 cases of osteosarcoma,12 Ewing’s sarcoma,1 case of recurrence of giant cell of bone,1 case of chondrosarcoma gradeⅡ.31 cases involved the distal femur and 20 cases involved the proximal tibia.There were 33 cases of tumor type knee arthroplasty,20 of which were located in the femur,13 in the tibia,18 in the femur,11 in the femur and 7 in the tibia.Results all 51 patients were followed up for 47~71 months,with an average of(58.0±3.0)months.14 patients(27.5%)died,23 patients(45.1%)had pulmonary metastasis,3 patients(5.9%)had local recurrence,6 patients(11.8%)had postoperative infection,and 5 patients(9.8%)survived without tumor.The mean score of the patients with tumor type knee prosthesis replacement was(24.5±2.1),and the mean score of the patients with vascularized fibula reconstruction was(26.1±1.7).Conclusion Limb salvage surgery has become the main treatment of malignant tumors around the knee joint.Tumor type knee prosthesis is the main reconstruction method,with the advantages of early weight-bearing,good stability,early complications and so on.The reconstruction of fibula with vascularization combined with massive allograft has certain advantages for the patients whose epiphysis is not obviously involved and whose expected survival time is longer,but there are many postoperative complications,so the indications must be strictly controled.

关 键 词：骨肿瘤 肿瘤型膝关节假体 同种异体骨 带血管蒂腓骨 

分 类 号：R738.2[医药卫生—肿瘤]