髓内钉结合骨水泥修复节段性骨缺损的疗效分析  

Repair of segmental bone defects with intramedullary nailing and bone cement

作　　者：田晋 林庆荣[2] 王磊[2] 胡岩君[2] 王华[3] Tian Jin;Lin Qingrong;Wang Lei;Hu Yanjun;Wang Hua(Department of Orthopaedics,Qiannan People's Hospital,Duyun 558000,Guizhou,China;Department of Orthopaedics,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Department of Orthopaedics,The First People's Hospital of Yichang,Yichang 443000,Hubei,China)

机构地区：[1]黔南州人民医院创伤骨科,贵州省都匀市558000 [2]南方医科大学南方医院骨科,广州510515 [3]湖北省宜昌市第一人民医院,443000

出　　处：《中华创伤骨科杂志》2021年第4期359-363,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨髓内钉结合骨水泥修复肿瘤切除术后节段性骨缺损的疗效。方法回顾性分析黔南州人民医院创伤骨科2018年4月至2019年9月收治的5例接受保肢手术治疗术后存留节段性骨缺损的四肢恶性骨肿瘤患者资料。其中男4例,女1例;年龄11~55岁,平均35.4岁;切除肿瘤病灶后骨缺损长度6~21 cm,平均12.3 cm;远期生活质量评估Karnofsky评分(KPS)均小于50分。其中3例患者采用带锁髓内钉固定加骨水泥填充进行修复重建,2例患者采用弹性髓内钉固定加骨水泥填充进行修复重建;其中2例因缺损21 cm、13 cm予钢板及外固定支架辅助固定。记录患者切除后缺损长度、手术时间、术中出血量,采用Enneking肢体肌肉骨骼肿瘤外科治疗重建术后功能评估、疼痛视觉模拟评分(VAS)、KPS评分评估疗效。结果5例患者顺利完成手术,手术时间112~225 min(平均154.2 min),术中出血量300~500 mL(平均为382 mL)。5例患者随访6~28个月,其中2例患者分别在术后6、7个月因疾病进展死亡。按Enneking肢体肌肉骨骼肿瘤外科治疗重建术后功能评估:1例28分,2例23分,2例21分,患者满意度较高。术后6个月的VAS评分1~6分,平均3.6分;术后KPS评分60~80分,平均72分。结论采用髓内钉结合骨水泥填充技术修复节段性骨缺损,可以缓解患者疼痛,近期疗效满意。Objective To investigate the clinical efficacy of intramedullary nailing combined with bone cement in repair of segmental bone defects after tumor resection.Methods A retrospective analysis was conducted of the 5 patients with malignant bone tumor who had been treated at Department of Orthopaedics,Qiannan People's Hospital from April 2018 to September 2019 for remaining segmental bone defects following limb salvage surgery.They were 4 males and one female,aged from 11 to 55 years(average,35.4 years).Their defects ranged from 6 to 21 cm(average,12.3 cm)after tumor resection.By the Karnofsky performance score(KPS)for long-term quality of life,all of them scored less than 50 points.Of them,3 were treated by interlocking intramedullary nails and bone cement filling,and 2 by elastic intramedullary nails and bone cement filling.In the 2 cases with defects of 21 cm and 13 cm,the fixation was assisted by a plate and an external fixator.Defect length after resection,operation time and intraoperative bleeding were recorded;the efficacy was evaluated by the Enneking functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system,visual analogue scale(VAS),and KPS.Results All the 5 patients had uneventful surgery,with operation time ranging from 112 to 225 min(average,154.2 min),intraoperative bleeding from 300 to 500 mL(average,382 mL),and defect length after resection from 6 to 21 cm.The 5 patients were followed up for 6 to 28 months.Of them,2 died of disease progression 6 and 7 months after surgery,respectively.According to the Enneking's evaluation,one patient scored 28 points,2 patients 23 points and 2 patients 21 points,giving a high degree of satisfaction.Their VAS scores 6 months after surgery ranged from 1 to 6,averaging 3.6;their postoperative KPS scores ranged from 60 to 80,averaging 72.Conclusion In repair of segmental bone defects after tumor resection,intramedullary nailing combined with bone cement filling can relieve pain of patients and lead to satisfactory

关 键 词：骨肿瘤 骨折固定术 髓内 肿瘤转移 

分 类 号：R687.3[医药卫生—骨科学]