保留自身关节的定制型假体与新轴心式膝关节假体在股骨远端骨肉瘤保肢治疗中的应用效果比较

目的 对比分析保留自身关节的定制型假体和新轴心式膝关节假体在股骨远端骨肉瘤保肢治疗中的临床疗效。方法 回顾性队列研究。纳入2012年8月—2019年3月上海市第六人民医院股骨远端骨肉瘤患者32例,其中男22例、女10例,年龄8~73(22.1±15.9)岁。本组32例新辅助化疗均有效,均行股骨远端瘤段切除假体重建术治疗。按照假体重建方式分组:保留自身关节的定制型假体组(定制组)12例,新轴心式膝关节假体组(新轴心式组)20例。比较两组患者术后1年的国际肌肉骨骼肿瘤协会(MSTS)评分系统的功能评分、美国特种外科医院(HSS)膝关节功能评分及术后肿瘤复发率,观察两组术后并发症以及保留自身关节的定制组中15岁以下的8例儿童患者术后双下肢长度差。结果 保留自身关节的定制组与新轴心式组术后1年MSTS评分分别为(26.6±2.6)分和(22.6±1.8)分,膝关节HSS评分分别(90.1±4.1)分和(70.4±5.1)分,差异均有统计学意义(t=5.019、11.375, P＜0.05);两组肿瘤复发率分别为2/12和15%(3/20),差异无统计学意义(P=0.620)。术后保留自身关节定制组出现1例假体髓内柄断裂、1例伤口不愈合,新轴心式组出现2例假体松动、2例伤口不愈合。定制组中,保留骨骺的15岁以下8例患儿中术后满2年者双下肢长度差均大于20 mm。结论 在满足严格的保肢适应证和标准的新辅助化疗前提下,对于距离膝关节面有一定安全距离的股骨远端骨肉瘤段切除假体重建治疗患者,相比于新轴心式膝关节假体重建,采用保留自身膝关节的定制型假体重建虽然不能解决儿童日后双下肢不等长的问题,但能最大限度地保留患者的膝关节功能。

Comparison of curative effect in native joint-preserving custom-made prosthesis and newly designed pivoted knee prothesis in treatment of patients with distal femoral osteosarcoma

Objective To compare the clinical effectiveness of native joint-preserving custom-made prosthesis and newly designed pivoted knee prothesis in treatment of patients diagnosed with distal femoral osteosarcoma.Methods A retrospective cohort study was performed on 32 patients diagnosed with femoral osteosarcoma and who underwent bone tumor resection and reconstruction with man-made prosthesis between January 2012 to December 2019. Radiography showed good response in neoadjuvant chemotherapy. Based on the constructive procedure, 12 cases were included in the native joint-preserving custom-made prosthesis group and 20 cases in the newly pivoted knee prosthesis groups. Post-operative Musculoskeletal Tumor Society score (MSTS) and Hospital for Special Surgery (HSS) score were compared at 12 months after surgery, and the rates of tumor recurrence were compared between two groups. Postoperative complications and difference of length of lower limb in children below 15 years old were observed.Results The MSTS scores after 12 months were (26.6±2.6) points and (22.6±1.8) points in native joint-preserving custom-made prosthesis and newly pivoted knee prosthesis groups, respectively. The HSS scores were (90.1±4.1) points and (70.4±5.1) points in native joint-preserving custom-made prosthesis and newly pivoted knee prosthesis groups, respectively. There were significantly statistical differences between two groups(t=5.019, 11.375, all P values＜0.05). The rate of tumor recurrence was 2/12 in native joint-preserving custom-made prosthesis group and 15%(3/20) in newly pivoted knee prosthesis group with no statistically significant difference (P=0.620). The fracture of the stem of prosthesis occurred in one case, and wound healing was delayed in one case in the native joint-preserving custom-made prosthesis group. Loose prothesis in two cases and delayed wound healing in one case were observed in the newly pivoted knee prosthesis group. No postoperative limb length beyond 20 mm was recorded in children below 15 years old more than 24 months after surgery.Conclusions Compared with the newly designed pivoted knee prosthesis custom-made prosthesis that aims to preserve the joint, based on strict surgical indications and the good response of neoadjuvant chemotherapy, the construction of native joint-preserving custom-made prosthesis is a safe and effective option for preserving joint function although it failed to reduce postoperative unequal length of lower limbs in children below 15 years old with growing up.