股骨上段肿瘤切除后人工假体重建的临床研究

目的探讨肿瘤广泛切除后人工假体置换治疗股骨上段恶性肿瘤的疗效,总结并发症发生情况。方法1998年7月至2005年7月,对81例股骨上段骨肿瘤的患者行广泛切除后人工假体置换,肿瘤类型包括股骨近端转移癌30例,股骨近端原发恶性骨肿瘤39例,股骨上段周围原发恶性软组织肿瘤4例,股骨上段纤维异常增殖症3例,其他5例。9例患者使用了灭活肿瘤骨结合人工假体复合重建缺损,5例患者行异体骨人工关节复合体重建,其余67例患者均使用金属假体。术后功能评价采用MSTS93评分。结果30例骨转移癌患者中,因术后均转往相关肿瘤科室行放、化疗,随访率较低,局部复发率不详,但术后短期关节功能良好。76例（93．8％）患者术后半年MSTS93评分平均在25分以上。51例原发肿瘤患者术后随访1．5～7．0年,平均3．5年。1例患者出现髋脱位;2例患者出现假体迟发感染;2例患者出现假体松动;2例患者发生移植物与宿主骨接合处不愈合;2例患者出现髋臼磨损;3例患者出现髋部疼痛,行走困难;1例患者出现假体的下沉。5例患者在术后0．5～2．0年内发生了局部复发。结论股骨上段恶性骨肿瘤切除后应用人工假体重建骨缺损,并发症较少,可以早期进行康复训练,术后髋关节功能良好,可作为股骨上段恶性骨肿瘤切除后的首选重建方法。

Endoprosthetic reconstruction after resection of the tumor of the proximal femur

OBJECTIVE: To evaluate the outcome and complications of endoprosthetic reconstruction after wide tumor excision on the patients with neoplasms at the proximal femur. METHODS: Between July 1998 and July 2005, 81 patients with tumor of the proximal femur were treated by wide excision and endoprosthetic reconstruction. Nine cases received devitalized bone and prosthesis composite reconstruction (among them, 3 patients of fibrous dysplasia had long stem bipolar hip replacement) and 5 cases had allograft prosthesis composite replacement. Two cycles of neoadjuvant chemotherapy were given to all the cases of osteosarcoma and Ewing sarcoma. The functional outcomes were evaluated by MSTS 93 score. RESULTS: Among the 30 patients with metastatic tumor, because all of them were transferred to related department to receive chemotherapy or radiotherapy after surgery, the follow-up was not doing well and the rate of local recurrence was not confirmed. Five patients with metastatic tumors died in 3 months after surgery. Most patients had excellent or good function postoperatively, the average MSTS 93 score was 25 in 6 months after surgery. Among the 51 patients with primary tumor, 2 patients had chronic infection and 2 patients had loosening of the prosthesis during the following time. Allograft bone and host bone nonunion were seen in 2 cases. Two patients with bipolar hip replacement had severe acetabulum abrasion. The other 3 patients also received total hip replacement for hip pain after walk. Five patients had local recurrence 6 months to 2 years postoperatively. CONCLUSIONS: Because of low complication rate and good postoperative function, endoprosthetic replacement is a good option for reconstruction of the proximal femur after tumor resection.