四肢骨肿瘤切除重建23例分析

目的:讨论四肢骨肿瘤瘤体切除,功能重建的效果。方法:分析23例四肢骨肿瘤行瘤体切除,不同方法重建后功能状况,其中转移瘤8例,骨巨细胞瘤6例,软骨肉瘤3例,骨肉瘤2例,尤文肉瘤2例,恶纤组1例,透明细胞肉瘤1例。采用髓内钉骨水泥重建9例,人工关节置换7例,自体腓骨移植重建4例,灭活再植2例,同种异体半关节置换1例。结果:瘤体灭活再植2例均复发,1例骨肉瘤于术后13月复发,1例软骨肉瘤术后4年6月复发,均再行肢体离断术;1例软骨肉瘤行肩关节置换术,2年后局部皮肤破溃,假体外露行翻修术;1例骨巨细胞瘤行定制膝关节假体置换术,术后6月出现窦道,经多次清创治疗,2年后行肢体离断术。结论:骨肿瘤切除后功能重建的方法较多,应结合病人的具体情况选择,灭活再植复发率高,并发症较多,人工关节置换后感染可导致保肢失败,自体骨及异体骨移植早中期效果良好,骨干部采用交锁髓内钉及骨水泥重建恢复快,效果满意。

The effect of 23 cases underwent extremities bone tumor resection and reconstruction

Objective：To discuss the effects of extremities bone tumor resection and functional reconstruction.Methods：This was a retrospective study enrolling the patients with 8 metastatic tumors,6 giant cell tumors,3 chondrosarcomas,2osteosarcomas,2Ewing＇s sarcomas and 1 malignant fibrous histiocytoma.Giant cell tumors were used Campanacci＇s staging system： 4 cases were classified as gradeⅡ,4 cases as grade Ⅲ.Primartumors were used Enneking grade： 2cases were classified as ⅠA,3 cases as ⅠB,4 cases as grade ⅢA.9 cases were reconstructed by interlocking mail and bone cement,7 cases by prosthetic replacement,4 cases by autogenous fibular graft,2cases by deactivational reimplant.Results：2cases reconstructed by deactivational reimplant recured,1 osteosarcoma which recured after operation 13 months and 1chondrosarcoma which recured after operation 4 years and 6 months were amputated.1 chondrosarcoma which was reconstructed by shoulder replacement infected and the prosthesis revealed after 2years.This case was revised.1 giant cell tumor reconstructed by total knee replaceed were infected and sinus emgerged after 6 months, although debridement was applied,the limb was amputated.Conclusion：Functional reconstruction methods is select according to the the patient characteristics. Deactivational reimplant＇s recurrence rate is high.Infection of prosthetic replacement resulted in the failure of limb salvage.Autogenous and allograft bone transplantation had good effect in the early and middle stage.Cases recovered quickly,which tumor in the diaphysis are reconstruct by interlocking mail and bone cement.