恶性肿瘤关节置换中人工补片的作用

目的探讨恶性肿瘤假体置换患者术中应用人工补片修复关节囊及软组织的效果及价值。方法回顾总结2003年1月-2008年6月肩、髋和膝关节周围恶性肿瘤非病理骨折患者行关节置换且获随访者35例，男19例，女16例，年龄23—82岁，平均50岁。肩关节置换10例，髋关节置换18例，膝关节置换7例。骨转移瘤21例，分别为肱骨近端及股骨近端；原发恶性骨肿瘤14例。将患者术前、术后关节功能按MSTS关节功能评价系统进行评定。所有患者均实施肿瘤广泛切除加人工假体置换，术中以人工补片修复关节囊。术后早期开始评价关节功能并积极功能锻炼、随访观察。对患者术后的临床结果进行分析评价。结果全部患者平均随访22个月（6个月～68个月），平均于术后5d拔除引流管，伤口均Ⅰ期愈合，无术后感染，未发生假体脱位。术前关节功能按MSTS关节功能评价系统测定20例为良、15例为可；而术后28为良、7例为可。所有患者最后随访时对治疗结果满意。结论应用人工补片修复肿瘤关节假体置换后的关节囊及软组织，对软组织缺损后的关节稳定性和动力重建有重要作用，临床效果满意。

Utility of artificial MESH for prosthesis replacement in malignant tumors

Objective To explore the application of the artificial mesh in reconstruction of the joint capsule and soft tissue in the case of malignant bone tumor treated with wide resection and prosthesis replacement. Methods From Jan 2003 to Jun 2008, 35 cases of malignant tumor near shoulder, hip and knee joint were treated by reconstruction surgery with prosthesis replacement. The function of joints were all evaluated preoperatively and postoperatively, based on MSTS evaluation system. The surgical procedure was regional wide resection and prosthesis replacement with joint capsule reconstructed by artificial mesh. All cases were followed up since immediately after operation. The clinical results were evaluated pre-operatively and post-operatively. Results There were 19 males and 16 females with an average age of 50 years, ranging from 23 to 82 years. The locations of tumor included 10 in proximal humerus, 18 in proximal femur and 7 in proximal tibia. 21 were secondary lesions and 14 were primary malignant bone tumors. All patients were followed up for 22 months, ranging from 6 to 68 months with well-healed incisions. The drainages were removed in an average of 5 days postoperatively. No infection of prosthesis or dislocation occurred. The fimctions of the joints were evaluated with MSTS system, resulted in 20 patients to be excellent and 15 good preoperatively, compared with 28 excellent and 7 good post-operatively. At the last follow up, all patients were satisfied with the results of surgery. Conclusion The artificial mesh plays an important role in increasing the stability of joints after prosthesis replaeement and improving the function of reconstructed soft tissues after wide resection. Satisfactory results has been obtained. Further investigations should be promoted.