交锁髓内钉在骨肿瘤术后功能重建中的应用 |
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引用本文: | 高书图,李东升,黄满玉,张志勇. 交锁髓内钉在骨肿瘤术后功能重建中的应用[J]. 中国骨肿瘤骨病, 2010, 9(1): 39-42. DOI: 10.3969/j.issn.1671-1971.2010.01.012 |
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作者姓名: | 高书图 李东升 黄满玉 张志勇 |
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作者单位: | 洛阳.河南省洛阳正骨医院,471002 |
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摘 要: | 目的探讨应用交锁髓内钉进行骨肿瘤术后功能重建的方法和疗效。方法29例患者,男14例,女15例。年龄21~73岁,平均35.5岁。其中骨囊肿病理性骨折4例,骨纤维异常增殖症病理性骨折1例,非骨化性纤维瘤病理性骨折1例,骨转移癌病理性骨折8例,骨转移癌未骨折4例,骨肉瘤11例。病变位于肱骨3例,胫骨2例,股骨24例。采取切开复位交锁髓内钉固定14例,瘤段切除灭活再植交锁髓内钉固定9例,瘤段切除异体半关节移植交锁髓内钉固定2例,预防性交锁髓内钉内固定4例。结果随访12~48个月,切开复位内固定14例中,骨转移癌8例,术后死亡5例,1例术后肿瘤范围扩大,余2例基本恢复到骨折前功能状况,6例良性患者,术后无肿瘤复发,骨折均愈合;瘤段切除灭活再植9例中,术后死亡2例,肿瘤复发1例,截骨不愈合1例,余5例愈合;瘤段切除异体半关节移植2例中1例愈合,1例不愈合。4例预防性内固定中,1例术后1年内死亡,余3例术后功能良好。结论交锁髓内钉在病理骨折内固定,自体骨灭活再植及异体骨移植重建中具有对位容易,固定可靠,可早期功能锻炼等优点,应用骨转移癌预防性内固定可有效避免病理骨折的发生。
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关 键 词: | 肿瘤 病理骨折 骨重建 内固定 |
The application of intramedullary interlocking nail in the function restoration after bone tumor resection |
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Affiliation: | GAO Shutu, LI Dongsheng, HUANG Manyu, et al. (Luoyang Orthopaedic Hospital, Henan, 471002, China ) |
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Abstract: | Objective To evaluate the application of intramedullary interlocking nail in the functional restoration after bone tumor resection. Methods A total of 29 patitents (14 men and 15 women) were involved. Their mean age was 35.5, ranged from 21 to 73. Four patients sustained pathological fracture caused by bone cyst; 1 sustained pathological fracture caused by bone-fibrous dysplasia; 1 sustained pathological fracture caused by non-ossifying fibroma; 8 sustained pathological fracture caused by hone metastases; 4 did not sustain pathological fracture caused by hone metastases; and 11 sustained osteosarcoma. The lesion was at the humerus (n=3), the tibia (n=2), and the femur (n=24). Fourteen patients underwent open reduction and intramedullary interlocking nail fixation; 9 underwent tumor segmental resection and inactivation followed by intramedullary interlocking nail fixation; 2 underwent tumor segmental resection and hemi-articular allograft transplantation followed by intramedullary interlocking nail fixation; and 4 underwent preventive intramedullary interlocking nail fixation. Results After the follow-up of 12 to 48 months, among the 14 patients who underwent open reduction, 8 sustained bone metastases, 5 died and 1 sustained expanded tumor range. Two of the other patients almost regained function. No relapse occurred in the 6 patients who had benign tumor, and their fractures all healed. One of the 2 patients who underwent tumor segmental resection and hemi-articular allograft transplantation followed by intrameduUary interlocking nail fixation recovered, and the other did not. Among the 4 patients who underwent preventive intramedullary interlocking nail fixation, 1 died within 1 year after surgery, but the other 3 regained good function. Conclusions In treating pathological fracture, devitalized bone replantation and allograft transplantation, intramedullary interlocking nail has the following advantages: easy contraposition, stable fixation, and early exercise. The bone metastases preventive internal fixation can avoid the occurrence of pathological fracture. |
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Keywords: | Tumor Pathological fracture Bone reconstruction Internal fixation |
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