定制人工假体置换治疗骨肿瘤的临床分析

目的：对应用定制肿瘤型人工假体置换治疗恶性骨肿瘤的临床疗效进行分析。方法回顾性分析我科2009年5月-2013年2月收治的恶性骨肿瘤患者29例，男18例，女11例；年龄17-65岁，平均38.5岁，股骨上端5例，股骨远端14例，胫骨上端7例，股骨下端3例。所有患者均接受对肿瘤进行广泛切除或根治性切除，包括综合性治疗及定制型人工假体置换治疗，术后对患者进行定期随访，对治疗效果进行评价。结果置换后1年采用MSTS保肢评分系统对随访患者进行功能评价，显示股骨远端患者（15.5-28.0）分，平均23.5分；股骨上端0.5-29.0分，平均23.5分；胫骨近端10.5-29.0分，平均22.4分。其中优9例，良15例，中4例，差1例，优良率为82.7%。术后并发症发生率为10.0%。1例患者于术后7个月死亡，1例患者于术后18个月后肺转移死亡，1例在术后13个月时出现局部复发现象而截肢，1例在术后8个月时出现局部复发单纯行瘤体切除。在随访时，所有患者均未出现人工假体断裂、松动现象。结论在骨肿瘤患者采用人工假体置换术前、术后给予综合性治疗，在对肢体功能加以保留，与其他重建方法相比，具有肢体早期负重、功能恢复快、使用期长的优点，患者生活质量大幅提高，是骨肿瘤保肢治疗的较理想选择，值得在临床中推广。

Analysis of the treatment of malignant bone tumors with the replacement of Customized tumor type prosthetic

Objective To analyze the clinical efficacy of the treatment of malignant bone tumors with the replacement of Customized tumor type prosthetic. Methods From May 2009 to February 2013, we did a retrospective analysis about 29 cases suffered malignant bone tumors, there were 18 males and 11 females, with average age of 38.5 years （ranged from 17 to 65）.5 cases on the proximal femur, 14 cases on the distal femur,7 cases on the proximal tibia, 3 cases on the distal tibia, which all treated by extensive excision or radical excision of the tumor including comprehensive treatment and the replacement of Customized tumor type prosthetic. Then analyzed the results of the treatment by following up. Results All patients were followed up with one year after surgery, to evaluate the function with MSTS limb salvage score system. The MSTS score was average 23.5 scores（ranged from 15.5 to 28.0） of the distal femur, and averaged 23.5 scores （ranged from 0.5 to 29.0） of the proximal femur, and averaged 22.4 scores （ranged from 10.5 to 29.0） of the proximal tibia. excellent 9 cases, good 15 cases, fair 4 cases and poor 1 cases. Excellent and good rate was 82.7%.The rate of Postoperative complication was 10.0%.One patient died after 7 months of surgery. One patient died of lung metastasis after 18 months of surgery. One patient amputated for local recurrence after 13 months of surgery. One patient suffered tumor resection for local recurrence after 8 months of surgery. There was no case what occurred the complications of prosthesis fracture and loosening. Conclusion The patients who were suffered malignant bone tumors, treated by the replacement of Customized tumor type prosthetic, and comprehensive treated before and after the surgery, then retain the function of the limb. There were advantages of early weight bearing, rapid recovery and using a long period compared with other reconstruction, significantly improve the quality of life of patients. It is an ideal treatment of the bone tumor and worth promoting in clinic