股骨远端球轴型旋转铰链膝关节的设计与临床应用  

Design and clinical application of the distal femur spherical motion axis hinge knee prosthesis

作　　者：徐明 张净宇 郑凯 于秀淳 胡永成[2] Xu Ming;Zhang Jingyu;Zheng Kai;Yu Xiuchun;Hu Yongcheng(Department of Orthopaedics,PLA 960th Hospital,Jinan 250031,China;Department of Bone and Soft Tissue Oncology,Tianjin Hospital,Tianjin 300211,China)

机构地区：[1]联勤保障部队第九六〇医院骨科,济南250031 [2]天津市天津医院骨与软组织肿瘤科,天津300211

出　　处：《中华骨科杂志》2023年第11期744-750,共7页Chinese Journal of Orthopaedics

基　　金：天津市卫生健康科研项目资助(TJWJ2022MS024)。

摘　　要：目的探讨球轴型旋转铰链膝关节假体重建股骨远端骨缺损的可行性及早期临床疗效。方法回顾性分析2019年10月至2021年11月联勤保障部队第九六〇医院及天津市天津医院收治的13例股骨远端原发肿瘤患者和3例膝关节周围假体置换术后翻修患者资料,男8例、女8例,年龄(43.3±17.8)岁(范围15~71岁)。13例股骨远端肿瘤患者中,骨肉瘤6例、骨巨细胞瘤5例、平滑肌肉瘤1例、软骨肉瘤1例;3例假体置换术后翻修患者中,肿瘤型假体术后无菌性松动2例、表面人工膝关节假体周围骨折1例。设计并制作球轴型旋转铰链膝关节假体重建16例患者肿瘤切除或假体翻修术后股骨缺损。术后定期随访,复查X线片评估下肢力线,采用中文版36条简明健康调查量表(36-item short-form,SF-36)评价术后生活质量,应用美国骨骼肌肉系统肿瘤协会(Musculoskeletal Tumor Society,MSTS)93膝关节功能评分评估肢体功能。结果16例患者均顺利安放假体,除2例行全股骨置换患者外,其余14例患者肿瘤切除后骨缺损长度(18.2±11.7)cm(范围8.6~47.1 cm)、手术时间(138±19)min(范围110~170 min)、术中出血量(211±118)ml(范围100~500 ml)。术后下肢全长正位X线片示16例患者下肢机械轴线与膝关节中心的距离为0.1(0,0.7)cm,髋膝踝角179.0°±2.3°(范围173.3°~182.2°)。术后随访12~36个月,16例患者均未发现假体并发症。SF-36评分显示生理功能评分为(56.7±7.0)分(范围42.7~67.4分)、心理功能评分(54.1±7.6)分(范围40.5~66.3分)。膝关节最大屈曲角度为120.0°±15.6°(范围95°~130°),其中肿瘤相关的15例患者MSTS 93评分为(25.0±1.7)分(范围22~28分),其中优7例、良8例。1例患者术后10个月出现肿瘤肝、肺转移,术后18个月死亡;其余15例患者至末次随访时均存活,无瘤生存时间为(25.8±8.4)个月(范围12~36个月),无局部复发及远处转移。结论球轴型旋转铰链膝关节重建股骨远端骨缺损,�Objective To investigate the feasibility and early clinical efficacy of spherical motion axis hinge knee prosthesis to reconstruct distal femoral bone defects.Methods A retrospective analysis was performed on 16 patients admitted to PLA 960th Hospital and Tianjin Hospital from October 2019 to November 2021,including 8 males and 8 females,with an average age of 43.3±17.8 years(range,15-71 years).There were 13 patients of primary tumors of the distal femur and 3 patients of postoperative revision of knee joint prostheses.Among the 13 patients with distal femur tumors,there were 6 cases of osteosarcoma,5 cases of giant cell tumor of bone,1 case of leiomyosarcoma and 1 case of chondrosarcoma.The reasons for revision after prosthesis replacement in 3 cases were:2 cases of aseptic loosening after tumor-type prosthesis and 1 case of periphery fracture of surface artificial knee prosthesis.A spherical shaft rotary hinged knee prosthesis was designed and fabricated to reconstruct postoperative femoral defects in 16 patients.Follow up regularly after the operation,recheck the X-ray film to evaluate the lower limb force line,evaluate the quality of life after the operation with the Chinese version of 36-item short-form(SF-36),and evaluate the postoperative limb function with the Musculoskeletal Tumor Society(MSTS)93 evaluation system.Results All 16 patients were successfully placed with prostheses,and except for 2 patients undergoing total femoral replacement,the length of bone defects was 18.2±11.7 cm(range,8.6-47.1 cm)in other 14 patients,and the operation time was 138±19 min(range,110-170 min),the intraoperative blood loss was 211±118 ml(range,100-500 ml).The postoperative full length orthostatic X-ray film of the lower limbs showed that the distance between the mechanical axis of the lower limb and the center of the knee joint was 0.1(0,0.7)cm in 16 patients,and the hip-knee ankle angle was 179.0°±2.3°(range,173.3°-182.2°).The patients were followed up for 12-36 months.No prosthesis complications were found in

关 键 词：假体设计 膝关节 股骨肿瘤 假体周围骨折 

分 类 号：R687.4[医药卫生—骨科学]