膝关节周围骨肉瘤保留关节保肢术后关节功能及生活质量的评价  

Evaluation of knee joint function and quality of life of patients with peripheral osteosarcoma of the knee treated by limb salvage with joint preservation

作　　者：侯子伟 郑凯 徐明 于秀淳 Hou Ziwei;Zheng Kai;Xu Ming;Yu Xiuchun(Department of Orthopaedics,the 960th Hospital,PLA Joint Logistics Support Force,Jinan 250000,China;the First Clinical Medical College,Shangdong University of Traditional Chinese Medicine,Jinan 250355,China)

机构地区：[1]解放军联勤保障部队第九六〇医院骨科,济南250000 [2]山东中医药大学第一临床医学院,济南250355

出　　处：《中华解剖与临床杂志》2020年第5期508-515,共8页Chinese Journal of Anatomy and Clinics

摘　　要：目的探讨膝关节周围骨肉瘤患者行保留关节的保肢术(JPLS)治疗后关节功能及生活质量情况。方法回顾性分析。纳入2000年11月—2019年12月解放军联勤保障部队第九六〇医院骨科膝关节周围骨肉瘤患者34例,其中男19例、女15例,年龄16~49(28.47±9.57)岁。按照手术方式分为两组,行JPLS的17例患者为保留关节组,行假体关节置换术(JPRS)的17例患者为假体置换组。另外选取2019年12月—2020年2月我科患者陪护人员中17名健康成人作为正常对照组,其中男8名、女9名,年龄18~50(29.83±10.25)岁。于术后12个月,分别采用骨骼肌系统肿瘤协会(MSTS)评分系统、国际膝关节委员会(IKDC)膝关节主观评分量表、生活质量简明健康问卷(SF-36)评价并对比较正常对照组、保留关节组、假体置换组下肢功能、膝关节功能及生活质量情况,比较保留关节组、假体置换组患者在MSTS、IKDC评分标准中各条目的分布情况。结果(1)正常对照组、保留关节组、假体置换组基线资料比较,差异均无统计学意义(P值均>0.05)。保留关节组、假体置换组34例患者均顺利完成手术,术后切口均一期愈合。(2)术后12个月,假体置换组MSTS评分为(22.82±5.47)分,低于保留关节组的(27.12±1.69)分和正常对照组的(28.18±1.78)分,差异有统计学意义(H=15.152,P<0.05);而保留关节组和正常对照组间MSTS评分差异无统计学意义(P>0.05)。假体置换组、保留关节组、正常对照组IKDC评分分别为(59.71±11.73)、(76.18±9.73)、(90.41±7.61)分,评分依次增高,差异均有统计学意义(H=33.283,P<0.05)。(3)术后12个月SF-36评分结果显示,假体置换组生理机能、生理职能、躯体疼痛、社会功能评分均低于正常对照组,健康变化评分高于正常对照组;而保留关节组健康变化评分高于正常对照组,生理机能、社会功能评分高于假体置换组:差异均有统计学意义(P值均<0.05)。SF-36量表中其他指Objective To investigate the joint function and quality of life of patients with osteosarcoma around the knee joint after joint salvage operation(JPLS).Methods Thirty-four patients with knee periarticular osteosarcoma admitted to the Department of Orthopaedics of the 960th Hospital of PLA Joint Logistics Support Force from November 2000 to December 2019 were analyzed retrospectively.Among them,17 patients who underwent JPLS were in the joint reservation group,17 patients who underwent joint prosthesis replacement(JPRS)were in the prosthesis replacement group.In addition,17 healthy patients from December 2019 to February 2020 were selected as the normal control group.The skeletal Muscle System Tumor Association Scoring System(MSTS),international knee committee(IKDC)knee master rating scale,and short form health(SF-36)questionnaire were used to evaluate the knee function,knee function,and quality of life in the normal control group,joint reservation group and prosthesis replacement groups.The distribution of items in the MSTS and IKDC scoring criteria was compared between the joint reservation group and prosthesis replacement group.Results(1)Baseline data among normal control group,joint reservation group and prosthesis replacement group were compared.No significant differencewas found among groups(all P values>0.05).All 34 patients in the joint reservation group and prosthesis replacement group successfully completed the operation,and all the incisions healed in one stage.(2)At 12 months after the operation,the MSTS scores in the prosthesis replacement group(22.82±5.47)were significantly lower than those in the joint reservation group(27.12±1.69)and the normal control group(28.18±1.78).Statistical differences were found among groups(F=15.152,P<0.05).No significant difference was found for MSTS scores between the joint reservation group and normal control group(P>0.05).The IKDC scores of the prosthesis replacement group,joint reservation group,and normal control groups were 59.71±11.73,76.18±9.73,and 90.41±7.

关 键 词：骨肉瘤 保留关节保肢术 股骨 胫骨 膝关节功能 生活质量 

分 类 号：R738.1[医药卫生—肿瘤]