膝关节周围恶性骨肿瘤不同保肢手术方法的比较

目的　回顾性总结膝关节恶性骨肿瘤不同保肢手术方法的临床效果 ,比较其各自的优缺点。方法　自1990年 1月 - 2 0 0 2年 3月行保肢手术的膝关节恶性骨肿瘤 6 3例 ,其中瘤段灭活再植 2 8例、异体骨移植 2 2例、人工假体置换 13例 ,按照Enneking方法分期 ,其中IB期 3例、IIA期 2例、IIB期 5 8例 ,比较 3种保肢手术后的局部复发率、并发症和膝关节功能MSTS评分。结果　局部复发率 :瘤段灭活再植的局部复发率为 2 1.4 % ,异体骨移植为 18.2 % ,假体置换为 15 .4 % ,三者之间没有显著性差异 ;人工假体置换的并发症明显小于其他两组。根据MSTS评分 ,人工假体置换组为 86 % ,瘤段灭活再植与异体骨移植分别为 6 5 %和 70 % ,差异显著性。结论假体置换具有并发症少 ,恢复快 ,功能好的优点 ,但对于青少年膝关节恶性骨肿瘤患者 ,尤其是骨骺没有愈合的 ,瘤段灭活再植及异体骨移植仍然是简单有效的方法

Limb Salvage for Malignant Tumors of the Knee

Purpose To report the experience of limb salvage with different methods for malignant tumors of the knee and discuss their advantages and disadvantages. Methods From January 1990 to March 2002,63 patients with malignant tumors of the knee underwent limb salvage surgery.After en bloc resection,28 cases were reconstructed with devitalized original tumor bearing bone,22 cases with allograft,and 13 cases with tumor endoprostheses.The local recurrences,complications and knee function of three different surgical methods were compared. Results Although the local recurrences of the three groups were similar (21.4% for the devitalized bone,18.2% for the allograft and 15.4% for tumor endoprotheses),tumor endoprotheses showed less complications and better knee function. Conclusions The present study shows that limb salvage with endoprotheses has less complication and better knee function,however,reconstruction with devitalized tumor bearing bone and allograft are still simple and useful tool for skeletal immature young patients.