术前化疗联合带关节同种异体骨植入及倒置髓内钉内固定治疗股骨下段恶性肿瘤的效果观察

目的探讨术前化疗配合带关节同种异体骨植入及倒置髓内钉内固定治疗股骨下段恶性肿瘤的临床疗效。方法选取本院2006年2月～2010年4月收治的股骨下段恶性肿瘤患者15例,采用术前化疗配合人工假体置换及倒置髓内钉内固定治疗患者7例为对照组,采用术前化疗配合带关节同种异体骨植入及倒置髓内钉内固定治疗患者8例为观察组,术后随访2年,比较两组患者各项临床指标并行ISOLS骨肿瘤术后功能重建评分。结果观察组愈合时间明显短于对照组,观察组膝关节主动活动度、ISOLS骨肿瘤术后功能重建评分、患者满意度均明显高于对照组,观察组并发症发生率明显低于对照组,差异均有统计学意义（均P〈0.05）。观察组复发率低于对照组,观察组1年生存率和2年生存率均高于对照组,但差异均无统计学意义（P〉0.05）。结论术前化疗配合带关节同种异体骨植入及倒置髓内钉内固定治疗股骨下段恶性肿瘤具有显著的临床疗效,不仅增强了人工关节固定臂功能,还减少了假体松动、断裂、下沉的发生,患肢术后功能重建良好,是一种安全有效的保肢治疗方法,值得临床推广使用。

Effect observation on distal femoral malignant tumor in the treatment with preoperative chemotherapy,belt joint allograft bone implantation,inversion of intramedullary nail fixation

Objective To investigate the clinical efficacy on distal femoral malignant tumor in the treatment with preopera tive chemotherapy,belt joint allograft bone implantation,inversion of intramedullary nail fixation.Methods 15 patients with distal femoral malignant tumor were selected in the hospital from February 2006 to April 2010.7 patients used preop erative chemotherapy,prosthesis replacement,inversion of intramedullary nail fixation in the treatment as the control group.8 patients used preoperative chemotherapy,belt joint allograft bone implantation,inversion of intramedullary nail fixation in the treatment as the observation group.The patients were follow up for 2 year.Various clinical indicators and ISOLS func tion restoration after bone malignant tumor resection score were compared between two groups.Results Healing time in the observation group was significantly shorter than that in the control group,active activity of knee joint,ISOLS function restoration after bone tumor resection in the observation group,patients satisfaction were significantly higher than those in the control group,complication rate in the observation group was significantly lower than that in the control group,there were significant differences about the index of two groups（all P0.05）.The recurrence rate in observation group was lower than that in the control group.1-year survival rate and 2-years survival rate in the observation group were higher than those in the control group,there was no significant difference between them（P0.05）.Conclusion The treatment of preoperative chemotherapy,belt joint allograft bone implantation,inversion of intramedullary nail fixation for distal femoral malignant tumor has obvious clinical curative effect,which not only can enhance the artificial joint fixing arm function,but also can reduce prosthesis loosening,fracture,sinking.The affected limb of postoperative functional reconstruction is good.That is a safe and effective salvage treatment method and worthy of clinical use.