定制肿瘤关节假体治疗复发性膝部骨巨细胞瘤的临床效果  

Clinical efficacy of custom⁃made tumor joint prosthesis for treatment of recurrent giant cell tumor of bone at the knee

作　　者：卢冬焱 杨波[1] 杨运发[2] 蒋柒 刘会毅 王建炜[2] 尹飚[1] 李远辉[1] Lu Dongyan;Yang Bo;Yang Yunfa;Jiang Qi;Liu Huiyi;Wang Jianwei;Yin Biao;Li Yuanhui(Department of Orthopedics,Third Affiliated Hospital of Guangzhou Medical University,Guangzhou,Guangdong 510150,China;Department of Joint Surgery,Guangzhou First Municipal People’s Hospital,Guangzhou,Guangdong 510000,China;Department of Orthopedics,Sichuan Provincial Orthopedic Hospital,Chengdu,Sichuan 610000,China)

机构地区：[1]广州医科大学附属第三医院骨科一区,广东广州510150 [2]广州市第一人民医院关节外科,广东广州510000 [3]四川省骨科医院老年骨科二病区,四川成都610000

出　　处：《广州医科大学学报》2021年第6期57-63,共7页Academic Journal of Guangzhou Medical University

摘　　要：目的:探讨瘤段切除+定制肿瘤人工膝关节置换术治疗复发性膝部骨巨细胞瘤(GCTB)的疗效。方法:回顾性分析2000年1月至2018年12月收治的因复发性膝部GCTB进行瘤段切除+定制肿瘤人工膝关节置换术的32例患者的临床资料,统计手术时间、术中出血量等围术期指标;采用Enneking骨骼肌肉肿瘤术后功能评分系统、膝关节功能HSS功能评分及VAS疼痛评分等进行随访评价。结果:平均手术时间(199.28±16.73)min,平均术中出血量(561.56±53.29)mL;术后切口均Ⅰ期愈合;患者均获随访,随访时间1.2~8.6年,平均随访时间6.2年,随访期间无肿瘤复发。末次随访时,Enneking功能评定优18例、良10例、可4例,总优良率达87.5%;术前及末次随访HSS膝关节功能评分分别为(47.34±2.71)分和(85.31±2.35)分,VAS评分分别为(7.09±1.28)分(7~10分)和(1.34±0.78)分(0~3分),两者比较,差异均有统计学意义(P<0.05)。末次随访,膝关节伸均可达0°,屈90°~120°。术后未出现感染、假体周围骨折、下肢深静脉血栓等并发症。结论:采用肿瘤瘤段切除+定制肿瘤型膝关节假体置换术治疗复发性膝部GCTB,不仅能缓解疼痛、保持完整的肢体形态,还能够有效保留膝关节活动功能,提高了患者远期生活质量。Objective:To determine the treatment efficacy of tumor segment resection+custom⁃made tumor artificial knee joint replacement in recurrent giant cell tumor of bone(GCTB)at the knee.Methods:The clinical data of 32 patients who underwent tumor segment resection+custom⁃made tumor artificial knee joint replacement due to recurrent GCTB at the knee between January 2000 and December 2018 were retrospectively analyzed.The perioperative indicators such as operation time and intraoperative blood loss were statistically analyzed.Enneking musculoskeletal tumor surgical resection postoperative functional scoring system,knee joint function HSS functional scoring and VAS pain scoring were used for follow⁃up evaluation.Results:The average operation time was(199.28±16.73)min,and the average intraoperative blood loss was(561.56±53.29)ml.All the incisions healed at the first stage after operation.All patients were followed up for 1.2 to 8.6 years,with an average follow⁃up time of 6.2 years.No tumor recurred during the follow⁃up period.At the last follow⁃up,there were 18 cases of excellent results,10 of good results and 4 of fair results by Enneking functional scoring,with a total excellent and good rate of 87.5%.The HSS knee function scores and VAS scores at baseline and at the last follow⁃up were(47.34±2.71)points and(85.31±2.35)points,(7.09±1.28)points(7⁃10 points)and(1.34±0.78)points(0-3 points),respectively,with statistically significant differences(P<0.05).The knee joint extension was 0°,and the range of flexion was 90°⁃120°at the last follow⁃up.No postoperative complications such as infection,fracture around the prosthesis,and deep vein thrombosis of the lower extremities occurred.Conclusion:Using tumor segment resection+custom⁃made tumor artificial knee joint replacement in the treatment of recurrent GCTB at knee may not only relieve pain and maintain complete limb shape,but also effectively retain knee joint mobility and improve the long⁃term quality of life.

关 键 词：骨巨细胞瘤 人工膝关节 瘤段切除 功能重建 

分 类 号：R681[医药卫生—骨科学]