仿生肿瘤型膝关节假体重建儿童股骨远端骨肉瘤切除后骨缺损  

Reconstruction with a bionic knee megaprosthesis after resection of a distal femoral osteosarcoma in children

作　　者：郭卫[1,2] 梁海杰 杨毅[1,2] 杜志业 臧杰[1,2] 汤小东 姬涛[1,2] 杨荣利 燕太强[1,2] Guo Wei;Liang Haijie;Yang Yi;Du Zhiye;Zang Jie;Tang Xiaodong;Ji Tao;Yang Rongli;Yan Taiqiang(Musculoskeletal Tumor Center,Peking University People's Hospital,Beijing 10044,China;Key Laboratory for Musculoskeletal Tu-mor ofBeijing 100044,China)

机构地区：[1]北京大学人民医院骨与软组织肿瘤治疗中心,北京100044 [2]骨与软组织肿瘤研究北京市重点实验室,北京100044

出　　处：《中华骨科杂志》2021年第4期201-210,共10页Chinese Journal of Orthopaedics

基　　金：首都卫生发展科研专项项目(新2020-2Z-4089)。

摘　　要：目的设计并应用仿生型股骨远端假体,通过人造韧带及高稳定型衬垫重建人工关节的稳定性,替代铰链式关节,从而降低相应部位的应力,降低假体磨损、松动及折断的发生率。方法回顾性收集2019年1月至2019年12月初治并行假体置换的股骨远端骨肉瘤的患儿资料,共纳入仿生型假体12例(仿生组)及单纯铰链假体21例(单纯铰链组)。仿生组男6例,女6例,年龄(8.8±2.6)岁,1例合并病理性骨折,Enneking分期ⅡA期1例,ⅡB期10例,Ⅲ期1例;单纯铰链组男14例,女7例,年龄(8.6±2.2)岁,3例合并病理性骨折,Enneking分期ⅡB期15例,Ⅲ期6例。通过对比仿生组和单纯铰链组的基线资料、手术相关资料、肿瘤学及假体预后情况,探讨仿生型股骨远端膝关节假体的围术期安全性、肿瘤学预后、术后并发症率及术后功能状态。结果仿生组和单纯铰链组在性别比例、年龄、身高、体重、发病时长等基线资料无显著性差异。仿生组在总手术时间(126.7±27.9)minvs(143.3±38.9)min(P=0.203)、术中出血量(162.5±212.3)mlvs(247.6±175.6)ml(P=0.224)及术后引流管保留时间(6.3±2.4)dvs(6.4±3.4)d(P=0.908)方面与单纯铰链组相似。仿生组平均随访(16.0±4.7)个月,1例因肿瘤进展死亡。3例出现远处转移,1例出现肿瘤复发合并假体半脱位,最终行截肢治疗。假体半脱位的原因可能是由于肿瘤巨大、股四头肌切除过多所致。余患儿未见假体并发症;单纯铰链组平均随访时间(12.7±4.5)个月,所有患儿均存活,其中3例出现远处转移,2例局部复发,均行局部切除;未见假体并发症。末次随访仿生组的膝关节活动度明显大于单纯铰链组(120.6°±13.6°vs 92.0°±7.7°,P<0.05),但MSTS 93评分的差异无统计学意义(29.1±0.9)分vs(29.5±0.6)分。结论短期随访结果提示,仿生型股骨远端膝关节假体与单纯铰链假体相比具有良好的围术期安全性,不增加假体并发症发生率,并可获得Objective We designed and applied a novel,bionic megaprosthesis for distal femur,which substituted the hinged articulation with an artificial ligament and a constrained tibial insert in order to maintain articular stability and reduce stress and the risks of wearing,loosening and breakage.Methods We reviewed the cases of distal femoral osteosarcoma in chil⁃dren population who were initially treated in our center during 2019.Twelve cases of bionic distal femoral prosthesis(bionic group)and 21 cases of fixed⁃hinge distal femoral prosthesis(control group)were included.In the bionic group,there were six fe⁃male and six male with the mean age as 8.8±2.6 y.One patient had pathological fracture.Staging according to Enneking system in⁃cluded 1 case of stage IIA,10 cases of stage IIB and 1 case of stage III.In the control group,there were seven female and fourteen male with the mean age as 8.6±2.2 y.Pathological fracture was seen in three cases.Staging included 15 cases of stage IIB and 6 cases of stage III.We investigated the peri⁃operative safety,oncological outcome,complication profiles and post⁃operative function⁃al status of the bionic prosthesis by comparing the baseline data,operative data,and oncological and prosthetic outcomes between the two groups.Results The two groups were comparable in terms of baseline data including gender,age,height,weight and on⁃set duration,and operative data including duration of operation(126.7±27.9 min vs 143.3±38.9 min,P=0.203),intra⁃operative hemorrhage(162.5±212.3 ml vs 247.6±175.6 ml,P=0.224)and duration of wound drainage(6.3±2.4 d vs 6.4±3.4 d,P=0.908).The mean follow⁃up duration of bionic group was 16.0±4.7 months,during which time three patients had systemic progression and one of them died of disease.Another patient had local recurrence and subluxation of the prosthesis that was treated by amputation.Sub⁃luxation might be related to the huge tumor mass and excessive resection of the quadriceps femoris.As for the control group,the mean follow⁃u

关 键 词：股骨肿瘤 假体设计 假体植入 仿生学 手术后并发症 

分 类 号：R738.1[医药卫生—肿瘤]