股骨干原发恶性肿瘤保肢手术中的重建策略  

Reconstruction strategy in limb salvage surgery for primary malignant tumor of femoral shaft

作　　者：卢新昌[1] 李甲振[1] 张岩[1] 张翼[1] 刘永奎[1] 闻嘉[1] 元耀博 李隆卿 Lu Xinchang;Li Jiazhen;Zhang Yan;Zhang Yi;Liu Yongkui;Wen Jia;Yuan Yaobo;Li Longqing(Department of Orthopedic Surgery,The first affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院骨科,450052

出　　处：《中华骨科杂志》2020年第18期1282-1290,共9页Chinese Journal of Orthopaedics

基　　金：河南省高等学校重点科研项目(20B320027)。

摘　　要：目的探讨股骨干原发恶性肿瘤保肢手术治疗及重建的方法,并分析其并发症及功能结果。方法回顾性分析2006年10月至2019年10月手术治疗并获得随访的37例股骨干原发恶性肿瘤患者资料,男22例,女15例;年龄(20.56±4.72)岁(范围:8~46岁)。37例Enneking恶性肿瘤分期均为ⅡB期,肿瘤病灶累及股骨长度范围10~24 cm,均未发生病理性骨折;术前行穿刺活检,病理确诊为骨肉瘤22例,软骨肉瘤8例,尤文肉瘤5例,恶性纤维组织细胞瘤2例。骨肉瘤与尤文肉瘤均行新辅助化疗。8例行人工全股骨假体置换术(置换组),14例行大段异体骨移植髓内钉内固定术(异体骨组),同种异体骨-假体复合物(allograft-prosthetic composite,APC)术8例(APC组),3D打印假体7例(3D打印组)。肢体功能按照世界骨与软组织肿瘤协会(Musculoskeletal Tumor Society,MSTS)93系统评分,对比分析各组之间肢体功能及优良率。结果37例随访时间(23.15±16.74)个月(范围:6~62个月)。至末次随访,9例(30.76%)出现肺转移,其中6例患者死于肿瘤多发转移,余28例无瘤存活。37例术后MSTS93评分(22.55±2.57)分(范围:18~28分),3D打印组为(27±1.74)分,异体骨组为(22.85±2.59)分,置换组(20.25±2.25)分,APC组(20.5±2.07)分,3D打印组功能评分与其他组之间有统计学差异(P<0.05)。总体下肢功能优良率为79.41%,其中3D打印组优良率为100%,异体骨组优良率为78.5%,APC组为87.5%,置换组优良率为62.5%,各组之间肢体功能优良率无统计学差异。置换组术后患者髋关节均未发生脱位,3例异体骨组及2例APC组异体骨段发生骨折不愈合;置换组1例术后血肿压迫坐骨神经,行急诊清创后神经功能恢复;1例术后伤口愈合不良经换药清创后愈合。总体并发症发生率为24.32%(9/37)。结论股骨干原发恶性肿瘤的患者通过肿瘤范围的不同选择合适的手术方案能够有效地恢复下肢功能,从而达到保肢的目的,改善患者生活质量;3D�Objective To explore the methods,complications and follow-up results of limb salvage for primary malignant tumors of the femoral shaft.Methods From October 2006 to October 2019,41 cases of primary malignant tumors of femoral shaft were analyzed retrospectively,37 cases were followed up,including 22 males and 15 females,aged 8-46 years with an average age of 20.56±4.72 years old.All the lesions were located in the femoral shaft,and The Enneking stage was IIB.Tumor lesion ranged in the femur from 10 cm to 24 cm,and there was no pathological fracture.Pre-operative puncture biopsy was performed in all cases.22 cases were confirmed as osteosarcoma,8 as chondrosarcoma,5 as Ewing sarcoma,2 as malignant fibrous histiocytoma.Neoadjuvant chemotherapy has been used to treat both osteosarcoma and Ewing sarcoma.Among the 37 patients,8 cases of patients received total femoral prosthesis replacement,14 cases of intramedullary nail fixation with allogenic bone graft,8 cases of allograft-prosthetic composite(APC),and 7 cases of 3D printed prosthesis.The limb function was graded according to MSTS 93 system.Results 37 out of 41 patients were followed up,and the average follow-up time was 23.15±16.74 months(6-62 months).There were 9 patients with pulmonary metastases(26.47%),among which 6 patients passed away due to multiple metastases.28 patients survived without tumor at last follow-up.The MSTS score was18-28(average of 22.55±2.57).The average score of 3D printing prosthesis group was 27±1.74,allogeneic bone transplantation group was 22.85±2.59,total femoral prosthesis replacement group was 20.25±2.25,and the APC prosthesis group was 20.5±2.07.There was statistical difference between 3D printing group and other groups.The overall excellent and good rate of lower limb function was 79.41%,in which the 3D group was 100%,allogeneic bone group was 78.5%,APC prosthesis group was 87.5%,total femoral prosthesis replacement group was 62.5%.There was no statistical difference in the excellent and good rate of limb function among the

关 键 词：股骨 股骨肿瘤 假体植入 骨重建 病例对照研究 

分 类 号：R738.1[医药卫生—肿瘤]