骨水泥型与非骨水泥型假体置换治疗膝关节周围骨肉瘤的疗效评价  

Effects of cemented and uncemented prostheses on knee peripheral osteosarcoma

作　　者：浦飞飞[1] 张志才 邵增务[1] 王佰川 刘建湘 吴强[1] 钟彬龙 PU Fei-fei;ZHANG Zhi-cai;SHAO Zeng-wu;WANG Bai-chuan;LIU Jian-xiang;WU Qiang;ZHONG Bin-long(Department of Orthopedics,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei,430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院骨科,武汉430022

出　　处：《中国骨与关节杂志》2021年第2期107-110,共4页Chinese Journal of Bone and Joint

基　　金：国家自然科学基金(81904231,82072978,82072979);中国博士后科学基金项目(2020M672369);湖北省博士后创新实践岗位项目(34);湖北省自然科学基金(2020CFB861);武汉市卫健委医学科研项目(WZ18Q05)。

摘　　要：目的回顾性分析骨水泥型与非骨水泥型假体置换治疗膝关节周围骨肉瘤的近期临床疗效。方法 2014年6月至2019年6月,71例累及膝关节周围骨肉瘤患者于我院行保肢治疗,男43例,女28例,平均10.4 (6~49)岁。接受骨水泥型和非骨水泥型假体置换分别54例和17例。采用MSTS功能评分对两种假体置换手术进行评分。结果所有患者随访10~76个月,平均31个月。骨水泥型和非骨水泥型假体置换组MSTS功能评分分别为(23.8±3.3)分、(25.9±1.7)分,两组差异有统计学意义(P <0.05)。骨水泥型假体置换组1例发生假体周围骨折,2例发生假体无菌性松动。非骨水泥组随访期间均未出现感染、假体脱位、假体松动等并发症。本组11例死于肿瘤相关疾病,48例无瘤生存,12例带瘤生存。24例(24/71,33.8%)术后4~29个月内发生肺部转移或其它部位多发转移,8例(8/71,11.3%)出现局部复发。结论随着骨肉瘤患者总生存期的延长和生存率的提高,对于预生存期较长、活动量较大且骨质较好的患者而言,非骨水泥型假体不失为一种有效的治疗选择。Objective To retrospectively compare short-term clinical effects of cemented and uncemented prostheses on knee peripheral osteosarcoma.Methods From June 2014 to June 2019,71 patients with knee peripheral osteosarcoma were treated with limb salvage in our hospital,including 43 males and 28 females with an average age of 10.4 years (range:6-49 years).There were 54 cases of cemented prostheses and 17 cases of uncemented prostheses.MSTS functional scores were used to compare the two prostheses.Results All patients were followed up for10-76 months with an average of 31 months.Statistical differences in MSTS function score were observed between the cemented prosthesis group (23.8±3.3) and uncemented prosthesis group (25.9±1.7) (P < 0.05).Periprosthesis fracture occurred in 1 case and aseptic loosening in 2 cases in the cemented prosthesis group;no infection,prosthesis dislocation,or prosthesis loosening was noted in the uncemented group during the follow-up.Eleven patients died from tumor-related diseases,48 patients survived without tumor,and 12 patients survived with tumor.Pulmonary metastasis or multiple metastasis occurred in 24 patients (24 / 71,33.8%) 4-29 months after surgery,while local recurrence was noted in 8 patients (8 / 71,11.3%).Conclusions Uncemented prosthesis is recommended as an effective option for patients with longer survival,higher activity requirement and better bone quality along with the prolongation of overall survival time and improvement of survival rate of osteosarcoma.

关 键 词：膝关节 股骨 胫骨 骨肉瘤 关节成形术 置换 膝 

分 类 号：R738.1[医药卫生—肿瘤]