大段异体骨关节移植的关节功能重建和术后康复

目的 探讨肢体恶性肿瘤切除后行大段同种异体骨关节移植、骨与软组织的修复重建及术后肢体功能康复的方法。方法 1992年5月－1999年1月，对90例肢体恶性骨肿瘤患者行瘤段切除后，应用不同内固定方式行深低温冷冻异体骨关节移植，术后随访时间18－89个月，平均37．5个月。依据Enneking肢体恶性肿瘤保肢术后功能评价标准进行判定。结果 ①皮肤坏死、早期感染、异体骨骨折及骨不连等是影响术后肢体功能康复的主要术后并发症；②90例患者后肢体功能优良率为73．3％，其中髋关节、膝关节异体骨关节移植术后肢体功能优于肩关节，异体骨段移植优于异体半关节移植，内锁髓内钉固定、异体骨段复合人工关节置换术优于普通的自制内锁髓内钉和加压钢板固定;③术后早期进行功能锻炼，利于肢体康复。结论 选择合适的手术适应证和内固定、完善的软组织修复重建及术后早期行肢体康复训练，大段异体骨关节移植可获得良好的肢体功能康复。

ALLOGRAFTING FOR MASSIVE BONE DEFECT: BONE AND SOFT TISSUE RECONSTRUCTION AND POSTOPERATIVE REHABILITATION

Objective To evaluate the results of limb function and the methods of bone and soft tissue reconstruction of patients treated with allografting. Methods From May 1992 to January 1999, 90 patients suffered from bone malignant tumor were treated with allografting in different methods of internal fixations. The average follow up was 37.5 months. The limb postoperative function, complications related to different surgical methods were compared according to Enneking evaluation system. Results Skin necrosis, infection, non union, fracture of allograft were the main complications which affect patients' limb postoperative functions. Of the 90 fresh frozen allografting procedures, the final results of operation showed that hip joints and knee joints were better than the shoulder joints. More than 80% of the patients treated with interlocked intramedullary nail and allograft prosthesis combination led to an over all result that was excellent and good. Interlocked intramedullary nail was of recommended method of internal fixation. Early exercises of operative limbs could promote function recovery. Conclusion Using of interlocked intramedullary nail and allograft prosthesis combination are of recommended operation method and can be applied with better results, and early exercises of operative limbs will lead to better functions.