人工全股骨关节置换治疗股骨骨肉瘤

Total femoral prosthesis replacement in management of femoral maligment bone tumor

目的探讨全股骨人工关节置换术治疗股骨骨肉瘤的适应证和并发症,评估术后功能结果。方法 1996年10月至2002年10月,采用全股骨人工关节置换术治疗骨肉瘤患者17例,其中男性8例,女性9例,年龄12～34岁,平均16岁;发病部位于股骨上段1例,股骨下段6例,股骨干10例;ⅡB期患者12例,ⅢB期5例;病灶范围23～28 cm,有跳跃灶3例,病理骨折2例;术前均行病灶活检,明确诊断。17例行术前化疗,15例术后化疗。手术经患肢外侧人路,人工全股骨假体置换。按照 MSTS 93系统检查肢体功能恢复情况。结果 17例患者均获得随访,平均45个月(9～120个月)。3例患者术后6～14个月局部复发(占17.6%)。ⅡB期12例患者中,4例死于肺转移(占33%);8例无瘤存活,存活时间50～120个月,平均75个月。ⅢB期5例,死亡5例,存活9～20个月,平均13个月。15例术后恢复行走,占88%,肢体功能恢复率40%～93%,平均74%。3例术后并发神经麻痹,2例术后髋关节脱位,无一例术后感染。结论全股骨人工关节置换术适用于股骨广泛受侵的恶性骨肿瘤患者,能有效恢复肢体功能;对于Ⅲ期患者,姑息性保肢治疗能有效地改善生活质量;人工全股骨关节的设计有待进一步改进。

Objective To discuss the indications of reconstruction with total femoral prosthesis for the patients with a majority of femur infiltrated by malignant bone tumor, and to evaluate the functional outcome and complication. Methods Detween October 1996 and October 2002, 17 patients with malignant bone tumor were treated with total femoral prosthesis replacement. The patients included 8 males and 9 females, whose age was from 12 to 34 years, with the average of 16 years. The lesions were located in the proximal femur metaphysis in 1, the distal femur metaphysis in 6, the femur shaft in 10, pathologic fracture in 2, skip lesions in 3. The extent of lesions was 23 - 28 cm （ a majority of femur infiltrated by malignant bone tumor ）. Preoperative pathologic diagnosis were established by open biopsy （2 cases） or needle biopsy （ 15 cases）. All patients were osteosarcoma. According to Enneking surgical staging system, the cases were 12 Ⅱ B and 5 IIIB. Seventeen cases received preoperative chemotherapy and 15 cases received postoperative chemotherapy. Results Seventeen cases were followed up with a mean time of 45 months （ range 9 - 120 months）. Local recurrence was observed in 3 （ 17.6% ） after operation 6 - 14 months. In 12 Ⅱ B cases, 4 cases（33% ） developed pulmonary metastasis and died. Eight cases remained continuously disease-free for average 75 montbs （range 50 - 120 months）. In 5 ⅢB cases, all with a mean survived term of 13 months （range 9- 20 months） died. Fifteen patients （88%） could walk. The patients had maintained average 74% （ range 40% -93% ） limb function scores evaluated by ISOLS criteria. Four cases had complications of paralysis of common peroneal nerve （ 3 cases） and dislocation of hip joint （2 case）. No infection took place. Conclusions Total femoral prosthesis replacement could be used in the treatment of the patients with a majority of femur infiltrated by malignant bone tumor and could effectively recover their limb function to a great extent. The procedure can effectively improve the quality of life for the patients with malignant bone tumor staging ⅢB.