人工补片在恶性肿瘤人工关节置换修补中的临床应用

The Clinical Application of Artificial PMH in Reconstruction of Joint Capsules after Prosthetic Replacement for Malignant Osteoma-Involved Joints

目的:对恶性肿瘤假体置换后的患者应用人工补片修复关节囊,探讨其方法和临床应用的价值。方法:回顾总结2003年8月～2005年4月肩、髋和膝关节周围恶性肿瘤病例10例,男7例,女3例;年龄43～65岁,平均52岁。病程3个月～2年,平均1年2个月。肿瘤生长在肱骨上段4例,股骨上段5例,胫骨上段1例。术前、术后10例患者患病关节功能按MTST关节功能评价系统评定。手术方法:所有患者均实施肿瘤广泛切除加人工关节假体置换术后用人工补片修复关节囊,并进行随访观察。对患者术前和术后的临床结果进行分析评价。结果:全部患者平均随访7个月,10例患者术后伤口引流管平均于术后5天拔除,伤口均Ⅰ期愈合,无术后感染并发症,未发生假体脱位。术前关节功能按MTST关节功能评价系统测定6例为良、4例为可;而术后8为良、2例为可。所有患者最后随访时对治疗结果满意。结论:应用人工补片修复肿瘤关节假体置换后的关节囊,对于其稳定性和动力重建起到了重要的作用,临床效果满意。

Objective： To discuss the methods and clinical application of the artificial PROLENE PMH, a polypropylene mesh patch, in reconstruction of the joint capsule, after prosthetic replacement due to malignant bone tumor. Methods： The data of 10 cases, including 7 males and 3 females with an average age of 52 years, with malignant tumor surrounding the shoulder joint, thigh joint or articulation of the knee diagnosed between August 2003 and April 2005, were retrospectively summarized. All of the patients received the artificial PMH for reconstruction of the joint capsule, after undergoing wide excision and prosthetic replacement. After follow-up, the results of the pre- and postoperative clinical results were analyzed and evaluated. Results： All patients were followed-up for a period of 3 months to ! year （average 7.5 months） and had well-healed incisions of stage I. The drainage tube was pulled out a median of 5 days after surgery （range, 4 to 7 days）. No infection of the incisions or dislocation of the prosthesis occurred. The joint function was evaluated according to the MTST assessment system of joint functions. Preoperatively, 6 joints were graded as fine and, 4 were acceptable. Postoperatively, and g joints were fine and 2 were acceptable. The therapeutic results for final follow-up of all of the patients were satisfactory. Conclusion： The articular capsule plays an important part in the stability of joints and the reconstruction of malignant tumor-involved joints after prosthetic replacement. Satisfactory resuits hasve been obtained using the PROLENE PMH.