肿瘤型假体置换术后再手术的原因与策略

目的 分析肿瘤型假体置换术后再手术的原因，探讨再手术的策略。方法 复习10年间再手术的21例患者。男13例，女8例。再手术时平均年龄37．3岁。再手术时间2周。20年。再手术的原因：肿瘤复发8例，假体松动5例，切口不愈合4例，关节脱位3例，假体断裂1例。行截肢术和肿瘤假体返修术各6例，肿瘤扩大切除术3例，病灶清除腓肠肌内侧头肌瓣转移术4例，切开复位术和关节旷置术各1例。结果 18例获得平均3年4个月的随访，死亡4例，余14例无异常。再手术后保留肢体功能满意率为84．6％，肢体功能优良率为53．9％。结论 肿瘤假体置换术后。再手术应根据不同的原因采取相应的治疗策略，在不违犯保肢手术的原则下，仍然可行保留肢体的手术，并可获得满意的治疗效果。

Revision procedures after prostheses implantation for bone tumors

Objective To analyze the causes of failure of limb salvage operations for bone tumor and to explore the therapies. Methods There were 13 male and 8 female patients with the mean age of 37.3 years old who had limb salvage procedures failure. The time between the first and re-operation was from 2 weeks to 20 years. The common reasons for re-operation were tumor recurrent in 8 patients and aseptic loosening in 5 cases and incision problems in 4 cases and joint dislocation in 3 cases and implant fracture in 1 case. Amputation and prosthesis revision were performed in 6 patients respectively. Three patients had en bloc resection and myo-skin flap translocation in 4 cases. The patient with internal hemipelvectomy had no reconstruction. Results 18 patients were followed-up with the mean time of 20.2 months. 4 patients died of disease. The satisfying rate of revision was 84.6% and the excellentgood rate was 53.9%. Conclusions Revision after limb salvage with prosthesis implantation were performed because of many reasons. Under the rules of limb savage, the preserving limb operations could undergo and could be with satisfactory limb function.