定制型人工关节置换治疗成人下肢近关节骨肿瘤的临床效果

目的探讨定制型人工关节在下肢近关节处肿瘤保肢术中的应用可行性。方法回顾分析我院2002～2007年接受定制型人工关节置换进行保肢治疗的下肢近关节处肿瘤患者46例，其中髋臼处肿瘤8例，股骨上段7例，股骨下段14例，胫腓骨上段17例。其中骨巨细胞瘤7例（复发性骨巨细胞瘤5例，骨折2例），骨巨细胞瘤合并动脉瘤样骨囊肿1例，骨母细胞瘤1例；恶性肿瘤37例，分别是成骨性骨肉瘤18例，转移性肿瘤6例（骨折2例），软骨肉瘤9例，恶性纤维组织细胞瘤3例（骨折1例），纤维肉瘤1例。所有患者均使用国产定制型假体。术前化疗1～2个疗程。结果术后46例中41例获12～65个月随访。术后3例皮下积液，2例局部皮肤坏死行皮瓣转位后治愈；1例外伤后股骨上段假体折断，行翻修术后可行走。2例术后分别于17、24个月局部复发行截肢术。术后肺转移6例，脑转移4例，恶性肿瘤最终保肢率91．6％。参照Enneking骨骼肌肉肿瘤术后肢体功能评定标准，优15例，良19例，可4例，差3例。术后2年生存率85．3％（35／41），3年生存率73．1％（30／411，5年生存率58．6％（24／41）。2年局部无复发87％，3年为73．5％，5年为64．7％。结论辅以围手术期综合治疗，人工假体置换术是下肢近关节恶性骨肿瘤解除疼痛、保肢、重建功能的一种有效方法。

Customized joint prosthesis replacement for bone tumor near joints

Objective To investigate the clinical outcomes of customized joint prosthesis replacement for bone tumor near joints. Methods Forty-six patients who underwent customized joint prosthesis replacement through Feb, 2002 to Feb, 2007 were involved. The tumor located at the acetabulum（n=8）, the proximal femur（n=7）, the distal femur（n=14） and the proximal tibia and fibula（n=17）. The tumor was recurrence giant cell tumor（n=5）, giant cell tumor which caused secondary bone fracture（n=2）, giant cell tumor accompanied with aneurismal bone cyst（n=1）, osteoblastoma（n=1）, osteogenous osteosarcoma（n=18）, metastasis turnor（n=6）, chondrosarcoma（n=9）, malignant fibrous histocytoma（n=3）, fibrous sarcoma（n=1）. All patients underwent 1 to 2 courses of pre-operative chemotherapy, and limb-savage procedure afterwards. Results Forty-one patients were followed up for 12 to 65 months. Three patients had subcutaneous hydrops. Two had skin necrosis and recovered after skin flap transfer. One had prosthesis damage of the proximal femur after trauma, and regained walking ability after revision. Two patients who had relapse underwent amputation 17 and 24 months after surgery. Six had metastasis in the lung, and 4 in the brain. The limb-salvage rate of malignant tumor was 91.6%. The outcomes were evaluated according to Enneking system. It was excellent in 15 patients, good in 19, fair in 4, and poor in 3. The survival rate after 2 years was 85.3% （35/41）. The survival rate after 3 years was 73.1% （30/41）. The survival rate after 5 years was 58.6% （24/41）. Two-year tumor-flee rate was 87%; 3-year tumor-free rate was 73.5%; 5-year tumor-free rate was 64.7%. Conclusions With peri-operative management, prosthesis replacement is an effective procedure to reduce pain, and to restore joint function