定制旋转铰链式膝关节假体置换治疗膝关节周围侵袭性骨肿瘤的临床观察

目的 观察定制旋转铰链式膝关节假体置换治疗膝关节周围侵袭性骨肿瘤患者的临床疗效.方法 回顾性分析2000年1月至2005年1月收治的27例膝关节周围侵袭性骨肿瘤患者的临床资料,其中股骨远端肿瘤13例,胫骨近端肿瘤14例;包括骨巨细胞瘤16例、骨肉瘤9例、滑膜肉瘤1例、恶性纤维组织细胞瘤1例.所有患者进行肿瘤切除、定制旋转铰链式膝关节假体置换治疗,术后进行康复治疗,恶性肿瘤患者进行常规化疗.术后随访,参照国际骨与软组织肿瘤协会(MSTS)评分标准进行膝关节功能评分.结果 所有患者随访11～122个月,中位时间64.5个月.术后6个月随访所有患者生存,MSTS评分为(22.2±3.5)分,膝关节功能优良率为81.5%(22/27).近期随访23例患者生存,4例患者死亡,4例发生与假体相关的并发症;其中22例生存患者MSTS评分为(21.0±2.3)分,膝关节功能优良率为72.7%(16/22).本组患者治疗后5年生存率为85.2%(23/27).结论 应用定制旋转铰链式膝关节假体置换治疗膝关节周围侵袭性骨肿瘤能获得良好的治疗效果.

Clinical evaluation of knee joint replacement with patient-tailored rotating hinge prosthesis in patients with invasive perigenual bone tumor

Objective To evaluate the clinical efficacy of knee joint replacement with patienttailored rotating hinge prosthesis in patients with invasive perigenual bone tumor.Methods Between January 2000 and January 2005, clinical data of 27 patients with invasive perigenual bone tumor were retrospectively analyzed, including 13 cases of distal femoral tumor and 14 of proximal tibial tumor,comprising 16 cases of giant cell tumors, 9 of osteosarcomas, 1 of synovial sarcomas and 1 of malignant fibrous histiocytomas.All the patients received resection of the tumor, knee-joint replacement with patienttailored rotating hinge prosthesis and postoperative rehabilitation.Patients with malignant tumor also underwent routine chemotherapy after surgery.MSTS scoring was used to evaluate the knee joint function in patients during the postoperative follow-up.Results All the patients were followed up for 11 to 122 months, with median time of 64.5 months.All the patients survived 6 months of follow-up, with a mean MSTS score of 22.2±3.5 and the rate of good knee joint function being 81.5% (22/27).In a recent follow-up, 23 patients were alive and 4 patients dead.Prosthesis-related complications developed in 4 patients.The mean MSTS score was 21.0 ±2.3, and the rate of good knee joint function was 72.7% (16/22) in 22 surviving patients.The overall rate of survival in all the patients was 85.2% (23/27) at five years after treatment.Conclusion The knee-joint replacement with patient-tailored rotating hinge knee prosthesis is associated with a good efficacy in treatment of invasive perigenual bone tumor.