股骨近端骨肿瘤及瘤样病变骨缺损的修复重建

Reparation and reconstruction of defect of tumor and tumor-like lesion in proximal femur.

目的探讨股骨近端骨肿瘤及瘤样病变骨缺损的修复重建方式。方法对自1998～2003年共49例股骨近端骨肿瘤或瘤样病变的手术治疗及术后疗效进行回顾性分析,本组中17例采取病变刮除,瘤壁烧灼,自体、异种骨、人工骨或复合移植术;12例采取病变刮除,瘤壁烧灼或酒精浸泡,自体骨、异种骨、人工骨或复合骨移植,并辅予内固定固定术;20例采取瘤段切除,定制人工关节假体重建关节术;术后均获随访。结果术后随访17～51个月,平均31个月,X线片可见缺损修复区内有骨降解和骨替代现象发生,2例复发,其中1例伴内固定物旁骨折,其余术后患肢功能恢复良好,4～12个月撤拐行走,无跛行;假体重建者1例假体断裂,1例死亡,根据Enneking术后功能评估系统,20例术后10～14月的评分73%～87%。结论根据肿瘤生物学行为及股骨近端生物力学选择个体化的修复重建方式,对股骨近端骨肿瘤及瘤样病变的疗效满意。

Objective To discuss the effective reconstruction of defect of tumor-like lesion in proximal femur.Method To make a retrospective analysis of surgical treatment and operation results of 49 patients with bone tumor or tumor-like lesion in proximal femur between 1998 and 2003.Surgery of curettage,bone grafting was performed in 17 cases,surgery of curettage,bone grafting and internal fixation in 12 cases,resection of tumor and re-construction of joint with custom-made prothesis was performed in 20 cases.Results During the follow-up time (17month-51month),X-ray film of postoperation showed bone union in defect in cases of bonegrafting.There were one death,one prothesis fracture and 2 recurrences,one of which was proximal femur fracture near the plate after the surgery.in cases of limb salvage,The score of functional evaluation of limb salvage was 73%～ 87%.Conclusion According to the tumorous biological behavior and the proximal femur biological mechanics,a effective reconstruction could be made for the defect of tumor and tumor-like lesion in proximal femur.