人工关节在四肢恶性骨肿瘤功能重建中作用

Arthroplasty in the functional reconstruction for extremity malignancy

目的 探讨人工关节在四肢恶性骨肿瘤功能重建后的疗效。方法 10例患者采用人工关节方法进行保肢治疗。局部肿瘤完整切除，人工假体重建术。其中1例胫骨近端行人工关节置换的同时作了腓肠肌肌皮瓣转移术。结果 随访7～27个月。3例骨肉瘤患者术后局部复发，行截肢术；1例术后2周切口出现渗液，经局部换药后愈合。患者均在术后2周开始行关节伸、屈、内收、外展等功能锻炼，膝关节伸0°、屈曲〉90°；髋关节功能均接近正常；肩关节外展70°、前伸60°、后伸45°、内收45°。结论 人工关节置换对四肢恶性骨肿瘤的治疗在功能重建方面，并发症少，功能恢复好，是一种保肢治疗的好方法。

Objectives To investigate the efficacy of arthroplasty in the treatment of extremity malignancy by functional reconstructive surgeries. Methods 10 patients included in this study were treated with prosthesis replacement in limb salvage surgeries for extremity malignancies. After tumor tissue being completely resected, bone structures were reconstructed with prostheses. 1 with proximal tibia tumor received local flap transplantation simultaneously. Results 10 cases were followed up for 7 - 27 months. 3 cases with osteosarcoma were found getting local recurrence, and then were treated with amputation. 1 got wound infection 2 weeks after surgery and was cured with debridement. Functional exercise was permitted since the third week after surgery. The function outcomes were extention 0°, and 〉 90° flexion in knee;normal extention ,flexion, adduction and adduction in hip; and adduction 70° ,flexion 60° ,extension 45° and adduction 45° for shoulder. Conclusions For patients with extremity malignancy, reconstructive surgery with arthroplasty is an ideal treatment due to less complications and better functional result.