人工关节异体骨复合移植修复骨肿瘤切除后的骨与关节缺损

Repairing bone and joint defect after tumor excision with allograft/prosthetic composite arthroplasty

目的:探讨人工关节异体骨复合移植修复骨肿瘤切除后的骨与关节缺损的外科技术.方法:25例骨肿瘤患者采用复合股骨上段的全髋置换12例、复合股骨下段全膝关节置换10例和复合胫骨上段的全膝关节置换3例.假体柄和异体骨、宿主骨界面采用骨水泥固定技术.10例骨肉瘤和4例恶性纤维组织细胞瘤患者手术前、后各接受6次大剂量静脉化疗.结果:25例患者随访36～112个月,平均64个月.术后无感染,无皮瓣坏死,1例股骨下段骨肉瘤术后关节积液经穿刺抽液后治愈.1例局部复发后截肢,1例股骨下段骨肉瘤患者于手术后37个月死亡,2例恶性纤维组织细胞瘤患者于25个月和33个月死亡,其余患者均为无瘤生存.本组患者术后无关节脱位和假体松动,2例股骨上段大转子部异体骨部分吸收,Trenberg征阳性.异体骨和宿主骨连接部均获得骨性愈合,愈合时间8～12个月,平均11个月.根据Enneking保肢术后功能评价标准,21例患者得分为17～27分,平均23.4分.2例胫骨上段肿瘤术后膝关节伸直缺失15°～20°.结论:人工关节-异体骨复合移植具有人工关节和异体骨两者优点的相加作用,采用骨水泥固定技术固定假体柄和异体骨、宿主骨界面符合异体骨愈合的特点,能满足患者的功能需求.

Objective： To assess the results and complications of allograft/prosthetlc composite arthroplasty for the bone and joint defect after tumor resection. Methods： Allograft/prosthetic composite arthroplasty included proximal femoral allograft with total hip arthroplasty （12 cases）, distal femoral allograft with total knee arthroplasty （10 cases）,and proximal tibial allograft with total knee arthroplasty （3 cases）. The bone cement was used to fix the prosthesis and allograft-host bone. Before and after operation,10 patients with osteosarcoma and 4 patients with malignant fibrous histiocytoma received high-dose chemotherapy for 6 cycles. Results： The mean duration of follow-up was 64 months （36 to 112 months）. Three patients died within 37 months. The remaining were alive with tumor-free, There were no dislocation or loose of the prosthesis. Two greater trochanters of the allogenous femur were partially absorbed. Synostosis was found at the allograft-host conjunction of all patients. Using the Enneking functional evaluation system, the mean postoperative score for all patients was 23. 4 with a range from 17-27. Conclusion： Allograft/prosthetlc composite arthroplasty has the advantages of both techniques and can meet the functional need of patients.