人工假体置换治疗髋部恶性骨肿瘤

Treatment of hip malignant tumor with arthroplasty

目的探讨应用人工假体置换治疗髋部恶性骨肿瘤的手术方法和疗效.方法应用人工假体置换治疗髋关节部位恶性肿瘤 14例,其中股骨上端假体置换12例,半骨盆假体置换2例.结果获随访11例,随访时间14 ～86个月,平均44个月.股骨假体置换12例中失访3例,术后肿瘤局部复发1例,无假体松动、术后感染病例;半骨盆置换2例中,术后发生松动,髋关节脱位1例,术后感染1例.术后1年内死亡2例,2年内死亡3例,3年内死亡2例;余4例髋关节功能良好,其中3例能不借助拐杖行走,1例需扶拐行走.结论股骨近端恶性肿瘤、特别是转移瘤并发骨折,人工假体置换术可立刻恢复骨骼的连续性及关节功能,效果良好;髋臼部恶性肿瘤切除后人工假体置换并发症较多,临床应用需慎重.

Objective To investigate the method and effect of arthroplasty in the treatment of hip malignant tumor. Methods 14 cases of hip malignant tumors were treated with arthroplasty, of which 12 were undergone proximal femoral prosthesis replacement and 2 were undergone semi-pelvie prosthesis replacement. Results 11 eases were followed up for 14 - 86 months, 44 on average. In the eases with proximal femoral prosthesis replacement, local tumor recurrent occurred in 1 case. No implant looseness or infection was found. In the 2 eases with semi-pelvic prosthesis replacement, 1 was complicated with implant looseness and hip dislocation and 1 with infection. Of all the cases, 2 died in 1 year, 3 died in 2 years and 2 died in 3 years： The rest 4 eases got good hip function, of which 3 can walk without crutch and 1 can walk with crutch. Conclusions For the proximal malignant tumor, especially matastatic tumor, arthroplasty can restore the skeletal continuitv and joint function and provide good results. It is associated with more complications in the treatment of acetabular malignant tumor with arthroplasty, which should be cautioned.