国产肿瘤型膝关节假体临床应用45例分析

回顾性分析1994-01/2002-12解放军济南军区总医院骨病科收治的膝关节周围恶性骨肿瘤患者45例，男28例，女17例，年龄13~57岁；股骨远端32例，胫骨近端13例；骨肉瘤27例，骨巨细胞瘤14例，恶性纤维组织细胞瘤1例，骨转移瘤1例，韧带样纤维瘤1例，软骨肉瘤1例。均采用国产肿瘤型膝关节假体置换，铰链式膝关节假体24例，旋转铰链式膝关节假体21例。参照骨肿瘤保肢术后肢体功能评价标准(MSTS93)，对生存患者的肿瘤型膝关节假体功能进行评分。45例患者平均随访64.9个月(12~156个月)，末次随访30例患者生存，15例患者死亡，其中骨肉瘤14例，骨转移瘤1例。8例发生与假体相关并发症，7例行翻修术，1例截肢。30例无瘤生存患者国产肿瘤型膝关节假体的1年生存率为96.67%，5年生存率为86.40%，10年生存率为62.7%；膝关节周围肿瘤型假体的总体平均评分为20.23分(7~27分)，优9例，良14例，中5例，差2例，患者肢体功能总的优良率为76.7%。提示采用国产肿瘤型膝关节假体治疗膝关节周围恶性骨肿瘤能获得满意的肢体功能和假体长期生存率。

Clinical analysis of domestic tumor prosthesis in 45 patients with malignant bone tumors around the knee

Forty-five patients with malignant bone tumors around the knee admitted to Department of Orthopedics, General Hospital of Jinan Military Area Command Region of Chinese PLA between January 1994 and December 2002 were retrospectively analyzed, including 28 males and 17 females aged 13 to 57 years. The distal femurs were involved in 32 cases, and the proximal tibia in 13 patients; 27 patients were diagnosed as having osteosarcoma, 14 as having giant cell tumor of bone, 1 as having malignant fibrous histiocytoma, 1 as having bone metastatic tumor, 1 as having desmoid tumor, and 1 as having chondrosarcoma. All patients underwent tumor resection and reconstruction with domestic prosthesis, including 24 patients with hinge knee prostheses, and 21 patients with rotating hinge knee prostheses. The affected limb functions were evaluated according to the Musculoskeletal Tumor Society (MSTS) score. The mean follow-up was 64.9 months (range 12 to 156 months). At the final follow-up, 30 patients were event-free alive and 15 patients were dead with osteosarcoma in 14 patients and bone metastatic tumor in 1 patient. Complications related to prosthesis occurred in 8 patients, prosthesis revision was performed in 7 patients, and amputation was performed in 1 patient. The event-free survival rate of 30 patients underwent replacement of domestic tumor prosthesis around the knee was 96.67% in 1 year, 86.4% in 5 years, and 62.7% in 10 years, respectively. The mean functional score of affected limb was 20.23 (7 to 27 points): excellent in 9 cases, good in 14, fine in 5 and poor in 2, and the excellent-good rate was 76.7%. The clinical outcomes suggested that the satisfactory limb function and survival rate could be achieved with the application of domestic tumor prosthesis replacement for the treatment of malignant bone tumors around the knee.