人工全股骨置换治疗股骨干骨肉瘤并相关文献复习

Total femoral prosthesis replacement for the diaphysial osteosarcoma:case report and the related literature review

目的 :分析探讨人工全股骨置换的手术适应证及手术操作要点。方法 :对 1例股骨干骨肉瘤患者的诊断分析及全股骨置换的治疗特点进行总结 ,并复习相关文献。结果 :股骨干骨肉瘤发病较少见 ,国内文献报道 2 2例 ,诊治困难 ;文献中全股骨置换国内报告 14例 ,国外报告 80余例 ,效果良好。作者应用MR的早期信号改变发现了股骨干肿瘤的侵袭范围 ,改良了传统手术切口及假体设计 ,使手术操作和假体设计更加完善。结论 :全股骨置换是治疗股骨干广泛病变较为理想的保肢方法。术前MR对发现病变的侵袭范围有重要价值 ;穿刺活检可明确诊断 ,为手术选择提供依据。术前假体的设计需要依据临床资料而确定 ;术中遵守无瘤操作 ,并最大限度保留下肢肌肉 ,是降低复发率 ,提高患肢功能的关键。

Objective:To study the clinical indication and surgical skill of the total femoral replacement for the diaphysial osteosarcoma.Method:Clinical features and the treatment of characteristics were observed with review of the related literature in one case of the total femoral replacement for the diaphysial osteosarcoma.Result:The diaphysial osteosarcoma was a special clinical type of osteosarcoma,it had low incidence,only 22 patients were reported in literature of our country.And the total femoral replacement was an option for the diaphysial osteosarcoma.The large lesions of the tumor was found with MRI examination,improving the traditional surgical operation and prosthesis design,making surgical operation perfectly.Conclusion:The total femoral replacement is an effective method for the diaphysial disease.MRI can find the involvement of soft tissue and nervovascular bundle by the tumor.The design of prosthesis should be corrected with the clinical data;it obeys to have no touch with the operation and combine the biggest limit reserve the legs muscle,which is a key to reduce the relapse rate and promote limb function.