保留与切除腓骨近段的肿瘤型膝关节假体治疗胫骨近端肿瘤的中长期肢体功能对照研究  

Mid-long term follow-up and functional evaluation of tumor type knee prosthesis replacement for malignant tumor of proximal tibia

作　　者：郑晓杰 万荣 张伟滨 ZHENG Xiao-jie;WAN Rong;ZHANG Wei-bin(Department of Orthopedics,Shanghai Institute of Traumatology and Orthopeadics,Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai,200025,China)

机构地区：[1]上海交通大学医学院骨科,200025 [2]上海交通大学医学院附属瑞金医院骨科、上海市伤骨科研究所,200025

出　　处：《中国骨与关节杂志》2022年第4期311-317,共7页Chinese Journal of Bone and Joint

摘　　要：目的针对我院采用瘤段切除肿瘤型膝关节假体置换治疗胫骨近端恶性肿瘤患者,比较保留腓骨近段与切除腓骨近段两组患者的中长期疗效和肢体功能评价及相关风险。方法回顾分析2010年1月1日至2017年12月31日,我院收治的胫骨近端原发性恶性肿瘤,且接受瘤段切除肿瘤型膝关节假体置换的58例的临床及随访资料,采用SPSS 26.0软件进行数据处理,计量资料组间用独立样本t检验,计数资料用χ^(2)检验,运用Kaplan-Meier法计算生存曲线及生存率,P<0.05为差异有统计学意义。结果58例随访6~161个月,平均(61.4±41.5)个月。5年总体生存率(over survival,OS)为80.7%。保留腓骨近段组22例,其中2例发生国际保肢学会(International Society of Limb Salvage,ISOLS)Ⅳ型失败。切除腓骨近段组36例,4例发生ISOLSⅣ型失败。假体柄高比例组假体10年存留率为80.6%,低比例组假体10年存留率为71.9%。比较保留腓骨近段与切除腓骨近段两组患者术后国际骨与软组织肿瘤协会(musculoskeletal tumor society,MSTS)评分、膝关节主动活动度和膝关节主被动活动度差值,可见保留腓骨近段组MSTS评分26.56±1.46优于切除腓骨近段组的24.85±1.95(P=0.012);保留腓骨近段组术后膝关节主动活动度(128.64±20.79)°优于切除腓骨近段组的(111.73±10.38)°(P=0.015);保留腓骨组术后膝关节主被动活动度差值(3.14±2.179)°小于切除腓骨近段组的(14.45±4.80)°(P=0.001)。结论胫骨近端原发性恶性肿瘤,若肿瘤未侵犯胫腓上联合或腓骨近段,采用胫骨瘤段切除肿瘤型膝关节假体重建时,宜尽可能保留腓骨近段,术后可获得更优的中长期肢体功能及膝关节主动伸屈功能,且不增加局部感染和复发而导致的假体失败风险。使用更长的胫骨侧假体柄能带来更好的假体预后。Objective Medium-and long-term efficacy,limb function evaluation and related risks of two groups with proximal fibula preservation or resection were compared in the management of patients suffered with primary malignant tumor at the proximal tibia and treated with Magaprosthese.Methods Clinical data of 58 patients with proximal tibial primary malignant tumors were retrospectively analyzed.All were treated with tumor resection and Magaprosthesis reconstruction from January 1,2010 to December 31,2017.SPSS 26.0(IBM)software was used for data processing;measurement data with independent sample t test;counting data withχ^(2) test.The survival curve and survival rate were calculated with Kaplan-Meier method,and P<0.05 was set as statistically significant.Results All 58 patients were followed up for 6 to 161 months,with an average of(61.4±41.5)months.The five-year overall survival rate(OS)was 80.7%.ISOLSⅣfailure occurred in 2 among 22 patients of the proximal fibula sparing group;in 4 among 36 patients of the proximal fibula resection group.The 10-year retention rate of prosthesis in the high-proportion group of prosthetic stem length was 80.6%,while low-proportion group 71.9%.MSTS(26.56±1.46 vs.24.85±1.95;P=0.012)and knee active range of motion[(128.64±20.79)°vs.(111.73±10.38)°;P=0.015]of the proximal fibula sparing group were better than that of the resection group.The difference value of active and passive range of motion of the proximal fibula sparing group(3.14±2.179)°was less than that of the resection group(14.45±4.80)°(P=0.001).Conclusions Proximal fibula preservation is recommended for tumor resection and Magaprosthesis reconstruction if the upper fibulotibial joint or proximal fibula is not invaded.It helps obtain better medium-and long-term limb function and knee active and passive range of motion,while not increasing the risk of prosthetic failure caused by local infection or recurrence.A longer stem length of Magaprosthesis may bring a better prosthetic prognosis.

关 键 词：胫骨 腓骨 骨肿瘤 骨肉瘤 人工膝关节 

分 类 号：R738.1[医药卫生—肿瘤]