人工肿瘤型假体置换术与保留骨骺的瘤段骨灭活再植重建术治疗膝关节周围骨肉瘤的疗效及预后比较  

Comparison of Efficacy and Prognosis of Artificial Tumor Type Prosthesis Replacement and Inactivation and Replantation with Preserved Epiphysis of Tumor Segment Bone in Treatment of Peri-Knee Osteosarcoma

作　　者：赵婷婷 李莎莎 张喻 冯翔 邱荣 刘双欢 ZHAO Tingting;LI Shasha;ZHANG Yu;FENG Xiang;QIU Rong;LIU Shuanghuan(Department of Orthopedic Operating Room,the First Affiliated Hospital of PLA Air Force Medical University,Xi′an 710032,China)

机构地区：[1]空军军医大学第一附属医院骨科手术室,西安710032

出　　处：《医学综述》2023年第20期4353-4357,共5页Medical Recapitulate

摘　　要：目的比较人工肿瘤型假体置换术与保留骨骺的瘤段骨灭活再植重建术治疗膝关节周围骨肉瘤的疗效及预后。方法选取2017年1月至2020年1月于空军军医大学第一附属医院行手术治疗的膝关节周围骨肉瘤患者94例,根据手术方式不同分为对照组(42例)和观察组(52例)。对照组采用人工肿瘤型假体置换术,观察组采用保留骨骺的瘤段骨灭活再植重建术。比较两组术后恢复情况、不良事件、复发、远期转移及远期生存情况。结果观察组美国骨肿瘤学会评分系统、国际保肢学会复合移植影像学评分系统评分高于对照组[(24±4)分比(21±5)分、(15.4±3.1)分比(12.2±2.6)分](P<0.01),膝关节主动背伸角度大于对照组[(73±8)°比(62±8)°](P<0.01)。观察组局部感染率低于对照组[7.69%(4/52)比23.81%(10/42)](P<0.05);两组钢丝外露、腓总神经不完全损伤、肌肉萎缩及截肢发生率比较差异无统计学意义(P>0.05)。两组患者均随访至2022年6月,随访时间为12~65个月,中位随访时间为32个月。观察组复发率低于对照组[17.31%(9/52)比35.71%(15/42)](P<0.05),两组远期转移率比较差异无统计学意义(P>0.05)。截止随访期限,对照组生存率为53.19%,观察组生存率为57.45%,两组Kaplan-Meier曲线比较差异无统计学意义(P>0.05)。结论与人工肿瘤型假体置换术相比,保留骨骺的瘤段骨灭活再植重建术可有效改善膝关节周围骨肉瘤患者术后恢复情况,降低局部感染率及复发率。Objective To compare the efficacy and prognosis of artificial tumor prosthesis replacement and inactivation and replantation with preserved epiphysis of tumor segment bone in the treatment of peri-knee osteosarcoma.Methods A total of 94 patients with peri-knee osteosarcoma who underwent surgical treatment in the First Affiliated Hospital of PLA Air Force Medical University from Jan.2017 to Jan.2020 were included and divided into a control group(42 cases,artificial tumor type prosthesis replacement)and an observation group(52 cases,tumor segment bone inactivation and replantation with preserved epiphyses)according to different surgical methods.The postoperative recovery,adverse events,recurrence,long-term metastasis and long-term survival were compared between the two groups.Results The Musculoskeletal Tumor Society 93 score and International Society of Limb Salvage composite transplantation imaging scoring system score of the observation group were higher than those in the control group(24±4 vs 21±5,15.4±3.1 vs 12.2±2.6)(P<0.01),and the knee active back extension angle was greater than the control group[(73±8)°vs(62±8)°](P<0.01).The incidence of local infection in the observation group was lower than that in the control group[7.69%(4/52)vs 23.81%(10/42)](P<0.05);there were no significant differences in the incidences of wire exposure,incomplete common peroneal nerve injury,muscle atrophy and amputation between the two groups(P>0.05).The patients in both groups were followed up until June 2022,with a follow-up time of 12-65 months(median,32 months).The recurrence rate in the observation group was lower than that in the control group[17.31%(9/52)vs 35.71%(15/42)](P<0.05),and the long-term metastasis rate between the two groups was not significant(P>0.05).By the end of the follow-up,the survival rate was 53.19%in the control group and 57.45%in the observation group.There was no significant difference in the Kaplan-Meier curves between the two groups(P>0.05).Conclusion Compared with artificial tumor type pros

关 键 词：膝关节周围骨肉瘤 人工肿瘤型假体置换术 保留骨骺 瘤段骨灭活再植重建术 

分 类 号：R738.1[医药卫生—肿瘤]