马鞍形人工半骨盆重建及术后康复治疗

背景马鞍形人工半骨盆重建术是在治疗髋臼巨大缺损的基础上发展而来的,近年来,国外学者将其用于治疗骨盆肿瘤取得了显著疗效.目的探讨马鞍形人工半骨盆重建术后的康复治疗方法及效果.设计以诊断为依据非随机非对照研究.地点和对象在中南大学湘雅医院骨科完成,对象为17岁男性患者,诊断为右侧骨盆骨巨细胞瘤Ⅱ级.干预对患者进行相当于Enekingand DunhamtypeⅡ+Ⅲ的半骨盆切除术.作病灶切除、马鞍形人工半骨盆重建术后,指导患者分阶段、渐进地进行患侧下肢距小腿(踝)、膝、髋关节的主动训练,调整步态.根据AboulafiaAJ的马鞍形假体置换术后整体结果评定标准进行结果评定.主要观察指标步行功能的恢复情况.结果术后1年患者步态仍稍跛,但户外活动不需带拐杖,患肢部分萎缩的大腿肌肉有改善,等级评定为优.结论患侧下肢距小腿、膝、髋关节的分阶段主动训练对马鞍形半骨盆重建术后的患者康复是可行和有效的.

Rehabilitativetreatment after reconstruction using saddle prosthesis

BACKGROUND: Reconstruction using saddle prosthesis, which was developed on the basis of treating the tremendous defect of acetabulum, has recently been used to treat tumor of the pelvis by foreign researchers with remarkable curative effects.OBJECTIVE: To explore the method and results of rehabilitative treatment after semipelvic reconstruction using saddle prosthesis.DESIGN: Nonrandomized and uncontrolled study according to the diagnosis.SETTING and PARTICHANTS: The study was completed in the Department of Orthopedics, Xiangya Hospital of Central South University. A 17year-old male patient, who was diagnosed as ahvinggiant cell tumor (grade Ⅱ)in the right pelvic, was studied.INTERVENTION: Semipelvic resection (hemipelvectomy)was performed on the right side due to giant cell tumor of bone, type Ⅱ + Ⅲ, which was classified according to the system of Eneking and Dunham. Meanwhile, semipelvic reconstruction was performed using saddle prosthesis. During the immediate inpatient period, the patient was instructed to carry out phasic and progressive rehabilitation training, including initiatively moving his ankle, knee, and hip joints of the affected extremity after operation, and to adjust his gait. According to the Aboulafia AJ' S criteria for grading overall results of patients, the patients' data of ambulatory revovery were recorded.MAIN OUTCOME MEASURES: The patient's data of ambulatory recovery were recorded.RESULTS: The patient felt no pain and could perform outdoor activities without the aid of cane. The atrophica muscle on thigh of affeted extremity was improved and the results were excellent.CONCLUSION: This preliminary report demonstrates that our phasic and initiative rehabilitation training can be recommended, with favorable results,to patients who received reconstruction using saddle prosthesis due to giant cell tumor of pelvis.