制型肿瘤膝关节假体在膝关节周定围肿瘤中的应用体会

目的探讨采用国产定制型肿瘤膝关节假体治疗膝关节周围肿瘤的临床疗效.方法对2004年6月~2011年10月应用定制肿瘤型铰链膝关节假体置换膝关节周围肿瘤的15例病人进行回顾性分析,男6例,女9例;年龄27~76岁,平均51.4岁.骨肉瘤4例,骨巨细胞瘤6例,非典型性纤维组织细胞瘤2例,软骨肉瘤3例,均为股骨远端肿瘤.均行瘤段广泛切除国产骨水泥定制肿瘤型铰链膝关节假体重建.结果全部15例随访14~96个月,平均32个月.术后切口均一期愈合,未出现感染、免疫排斥、皮肤会死等近期并发症.1骨肉瘤患者术后10个月出现局部复发,拒绝手术,术后16个月死亡,1例骨肉瘤患者18个月肺转移死亡,1例骨肉瘤患者术后3年局部复发截肢.所有患者无关节脱位、假体松动、断裂、肢体短缩.术后膝关节主动屈曲活动度70~120°,平均89.4°,末次随访ISLOS影像评分24~31分,平均28.6分;骨肿瘤术后MSTS功能评分21~25分,平均22.8分.结论对膝关节周围恶性与侵袭性骨肿瘤切除后骨缺损采用国产定制肿瘤型人工假体重建是有效的保肢方法.

The clinical efficacy of tumors of domestic custom knee prosthesis around the treatment of knee tumor

Objective To investigate the clinical efficacy of tumors of domestic custom knee prosthesis around the treatment of knee tumor.Methods Application customization around the tumors of tumor type hinge knee prosthesis replacement knee in June 2004 to October 2011 15 patients were analyzed retrospectively,6 males,9 females;aged 27 to 76 years,an average of 51.4 years old.4 cases of osteosarcoma,6 cases of giant cell tumor,atypical fibrous histiocytoma of the 2 cases,3 cases of chondrosarcoma,are the distal femur tumors.Line by tumor wide resection domestic bone cement customize the tumor type hinge knee prosthesis reconstruction.Results All 15 cases were followed up for 14 to 96 months,an average of 32 months.All incisions healed without infection,immune rejection,the skin will die and short-term complications.An osteosarcoma patients 10 months after local recurrence,refused surgery,16 months after death,one cases of 18 patients with osteosarcoma lung metastasis to death,one cases of osteosarcoma patients after 3-year local recurrence amputation.All patients without dislocation,loosening of the prosthesis,fracture,limb shortening.Postoperative knee active flexion activity of 70°to 120°,average 89.4 °,the last follow-up ISLOS image score of 24 to 31 points,with an average of 28.6 points;bone tumor surgery MSTS functional score of 21 to 25 points,an average of 22.8 points.Conclusions Domestic custom tumor prosthesis reconstruction of bone defects around the knee malignant and aggressive bone tumor resection is an effective limb salvage.