肿瘤型人工关节重建下肢骨肉瘤切除后的骨缺损郭卫姬涛杨毅【摘要】目的总结应用肿瘤型人工关节重建下肢骨肉瘤切除后骨缺损的效果及并发症。方法1997年7月～2004年7月共对167例下肢骨肉瘤实施广泛性切除后人工假体重建保肢术,100例获得随访。其中男56例,女44例。年龄13～57岁。股骨近端5例,股骨远端57例,胫骨近端38例。Enneking分期�A期3例,�B期85例,�期12例。使用国产假体71例,进口假体29例。17例患者采用灭活肿瘤骨结合人工假体复合重建缺损,21例采用异体骨人工关节复合体,余62例采用人工假体进行重建。所有成骨肉瘤患者术前均行1～2个疗程规范化疗,术后3～5个疗程化疗。术后采用MSTS保肢评分系统对随访患者进行功能评价。结果所有患者获随访1～8年,中位随访时间315年。人工关节3年生存率为8118%,5年生存率为65%。6例假体折断,13例假体迟发性感染,2例假体松动,5例移植物与宿主骨接合处不愈合,2例异体骨吸收,2例假体下沉,1例骨折。7例于术后6个月～2年内肿瘤局部复发,其中软组织肿瘤复发4例,接受肿瘤再切除治疗;另3例接受截肢手术。患者MSTS评分平均为23130±5117。肢体功能优62例,良27例,中7例,差4例,优良率为89%。结论与其他保肢重建方法比较,肿瘤型人工关节能保留最好的关节功能。但并发症发生率仍较高,人工关节的设计及加工有待于进一步改进。【关键词】骨肿瘤复合关节重建中图分类号:R738.1R318108文献标识码:AENDOPROSTHETICRECONSTRUCTIONAFTERWIDERESECTIONOFSARCOMAINLOWEREXTREMITIES�GUOWei,JITao,YANTYi.MusculoskeletalTumorCenter,People’sHospital,PekingUniversity,Beijing,100044,P.R.ChinaCorrespondingauthor:GUOWei,E2mail:bonetumor@163.com【Abstract】ObjectiveToassesstheclinicaloutcomeofthelimbsalvagesurgeryandcomplicationsoccurringinthelowerextremitiesafterawideresectionofsarcoma.MethodsAtotalof167patientsunderwentalimb2sparingprocedurebymeansoftheimplantationofacustom2madeormodulartumorendoprosthesisfromJuly1997toJuly2004.Ofthe167patients,100werefollowedup,including56malesand44females,withtheiragesrangingfrom13to57yearsatsurgery.In5patients,aproximalfemurprosthesiswasimplanted;in57patients,adistalfemurprosthesiswasimplanted;andin38patients,aproximaltibiaprosthesiswasimplanted.AccordingtotheEnnekingstaging,3patientsweregroupedinthestageof�A,85in�B,and12in�.Seventy2onepatientsusedadomesticprosthesis,and29patientsusedaprosthesismadeinLinkCompany,Germany.Forthereconstruction,17patientsusedanautograftprosthesiscomposite,21patientsusedtheallograftprosthesiscomposite,andtheremaining62patientsusedanartificialprosthesis.Allthepatientsreceivedchemotherapyfor122coursesand325coursesbeforeoperationandafteroperation,respectively.Afteroperation,TheMusculoskeletalTumorSociety(MSTS)scorewasusedtoevaluatetherecoveryoftheircorrespondingfunctions.ResultsAccordingtothefollow2upfor128years,withamedianof315years,andtheassessmentbytheKaplan2Meierestimate,the32yearsurvivalrateoftheprostheseswas81.8%,andthe52yearsurvivalratewas65%.Asforthecomplications,prosthesisbreakageoccurredin6patients,periprosthesisinfectionin13patients,asepticlooseningin2patients,non2unionbetweenthehostboneandgraftbonein5patients,allograftabsorptionin2patients,prosthesissinkingin2patient,andperiprosthesisfracturein1patient.Localrecurrencedevelopedin7patientswithin6monthsto2yearsafteroperation.Ofthe7patients,4hadarecurrenceofthesofttissuetumorforwhichresectionwasperformed;theother3patientsunderwentamputationofthediseasedlimb.ThemeanMSTSscorewas23.30±5.17,withanexcellentlimbfunctionin62patients,goodin27patients,fairin7patients,andpoorin4patients.Theoverallexcellentandgoodfunctionwasobtainedin89%ofthepatients.Conclu...
