膝关节周围恶性肿瘤患者不同保肢治疗术后康复效果观察

Postoperative rehabilitation effects for patients with bone tumors around knee joint by different limb conserving operations

目的探讨不同保肢方法治疗膝关节周围恶性骨肿瘤术后的康复效果。方法收集1994年1月-2004年10月收治的膝关节周围恶性骨肿瘤患者39例。按照Enneking分期：ⅠB期13例，ⅡA期3例，ⅡB期23例。39肢均行肿瘤节段截除、肢体重建手术。其中人工关节置换16例、复合骨移植16例、旋转成形7例。对不同的患者术后采用不同的康复方法、时间和强度，比较3种保肢手术后局部复发率、并发症和膝关节功能MSTS评分。结果人工关节置换术后局部复发率为12．5％。复合骨移植术后局部复发率为12．5％，旋转成形术后无局部复发；术后平均膝关节功能MSTS评分：人工关节置换术88．0％，复合骨移植术88．7％，旋转成形术68．0％，3种术式比较差异有统计学意义。结论人工关节置换术和复合骨移植术应用于相对局限、无转移的膝关节周围恶性肿瘤，配合适当的康复训练，具有并发症少、恢复快、功能好等优点，但仍有一定的转移率和局部复发率。旋转成形术局部复发率低，但术后功能较差。

Objective In order to know the postoperative rehabilitation condition for patients with bone tumor around knee joint by different limb conserving operations. Methods Selected 39 patients with bone tumor around knee joint, there were 13 cases of Enneking-ⅠB, 3 cases of Enneking- ⅡA and 23 cases of Enneking-Ⅱ B. There were 16 cases had accepted artificial joint replacement, there were 16 cases who had accepted composite bone transplantation, the others had accepted rotating form operation. Compared the postoperative rehabilitation condition among patients with different limb conserving operations. Results The local recurrence rate of patients with artificial joint replacement was 12.5%,the same in the patients with composite bone transplantation, while there was no recurrence case among patients with rotating form operation. The MSTS scores in the postoperative patients with artificial joint replacement, composite bone transplantation and rotating form operation was 88.0%, 88.7% and 68.0% respectively, the difference was significant. Conclusion The artificial joint replacement and composite bone transplantation have the merits of speedy rehabilitation with little complications. The rotating form operation has low recurrence rate but poor postoperative function.