长骨肿瘤假体置换术长期疗效分析

1971～1990年,对29例长骨原发性肿瘤或瘤样病损,施行瘤段切除,金属假体置换。部位肱骨近端5例;股骨近端12例;胫骨近端2例;股骨远端9例;桡骨远端1例。其中侵袭性骨巨细胞瘤21例:软骨肉瘤3例;骨肉瘤1例;恶性纤维组织细胞瘤1例;动脉瘤性骨囊肿3例。对26例进行了1～19年随访,平均8年。功能优良者16例(占62%);假体柄断裂2例;假体早期脱位1例;局部复发3例;迟发感染3例;1例因肺部转移而死亡。手术的关键是:保证瘤段彻底切除,预防术后感染和改进假体设计。

An Analysis of Long-term Results of Prosthesis Replacement for Tumors of the Long Bone

From 1971 to 1990, 29 primary bone tumors and tumor-like lesions have been resected, with joint reconstruction by massive prosthetic replacement and limb salvage. The tumors were located at the proximal end of humerus (5 cases), femur (12 cases), and tibia (2 cases), and at the distal end of femur (9 cases), and radius (1 case). Among them, there were aggresssive giant cell tumor (21 cases), chondrosarcoma (3 cases), ocsteosarcoma (1 case), malignant fibrous histocytoma (1 case), aneurysmal bone cyst (3 case). Follow-up extended from 1 to 19years (average, 8 years) in 26 cases. The functional results were excelllent or good in 16 cases (62%), wehile fracture of prosthetic stem occurred in 2 cases, early dislocation in 1, local recurrence and late infection in 3 each, and one patient died of lung metastasis. The key of success of the operation depended on the completeness of radical resection of the tumor hearing bone segment, on the prophylaxis of post-operative infectionn, and on the careful design of the prosthesis.