膝关节周围骨肿瘤的保肢治疗

The Surgical Treatment for the Tumor Around the Knee Joint

目的 探讨应用新轴心、旋转式肿瘤人工膝关节假体（CLDX）置换和大段灭活同种异体骨移植内固定术治疗膝关节周围骨肿瘤的适应征及影响疗效的因素。方法 9例（9膝）患有股骨远端或胫骨近段骨肿瘤的患者行包膜外瘤体边缘切除，应用CLDX置换，2例患有股骨远端肿瘤的患者行股骨远端瘤段切除，大段灭活、同种异体骨移植带锁髓内钉内固定手术。结果 11例膝关节周围骨肿瘤术后的患者均获得随访，随访时间6～27个月，平均9个月。术后11例短期随访均无复发、感染、松动和折断发生。2例大段灭活同种异体骨植入带锁髓内钉内固定患者X线片对比，无骨痂形成，间隙有部分骨吸收。11例患肢屈伸活动均为0～100°。根据InsallN评分标准治疗后效果优6例，良3例，可2例，优良率81．8％。结论 膝关节周围骨肿瘤包膜外瘤段切除，应用CLDX置换和大段灭活同种异体骨移植内固定术治疗，适应症选择适当，短期疗效满意。

Objective To study the results and operative indications of rotating-hinge endoprosthesis （CLDX） or large autograft and internal fixation after resection for the tumor around the knee joint. Methods Nine cases （9 knees） with tumor lesion who were involved with proximal tibial and distal femur were treated by radical resection and replaced by CLDX and2 cases were treated with large autograft and internal fixation after resection for the tumor around the knee joint. Results Eleven cases were followed up from 6 to 27 months, averaged 9 months. Excellent 6 cases, better 3 cases and 2 failure. Nothing happened for all the cases including tumor recovery, infection, loose and pathological fracture. Conclusion Using rotating-hinge endoprosthesis （CLDX） or large autograft and internal fixation after resection for the tumor around the knee joint is a good method.