应用人工假体及复合大段异体骨移植治疗不同位置胫骨恶性骨肿瘤

Prosthesis combined with massive bone allograft for tibial malignant tumor in different locations

目的:回顾性分析39例胫骨恶性肿瘤患者的临床资料,探讨不同部位的胫骨恶性骨肿瘤采用适合的保肢术式。方法:选择1999-01/2007-03云南省肿瘤医院骨科收治的胫骨恶性肿瘤手术患者39例,按肿瘤分布上、中、下段不同部位采用瘤段切除+异体骨关节移植,旋转轴心式铰链型人工膝关节置换,大段异体骨关节移植+旋转轴心式铰链型人工膝关节复合移植,大段骨灭活再植术,半膝关节移植术等术式治疗。术后随访≥2年,记录5年生存率,观察并发症,材料宿主反应,并按Mankin标准评价功能结局。结果:39例胫骨恶性肿瘤患者中10例术后6个月～2.2年内因肿瘤全身性转移而死亡,28例存活,5年存活率为74%。存活者中,4例因局部复发而截肢,1例复发者行瘤段截除大段异体骨植骨融合术后治愈。功能结局为优者20例,良8例,中6例,差5例,患者术后满意率72%。结论:对胫骨恶性骨肿瘤应当根据肿瘤类型、部位等采用最佳的保肢术式,才能达到最好的临床效果。应用人工假体以及复合大段异体骨移植术效果优于自体骨灭活再植。

AIM： To retrospectively analyze the clinical data of patients with tibial malignant tumor, so as to explore the limb salvage for tibial malignant tumor of different locations. METHODS： Thirty-nine cases with malignant tumor in tibia admitted in Department of Orthopedics, Yunnan Tumor Hospital from January 1999 to March 2007 were selected. According to the location of tumors, surgeries such as tumor segment resection ＋ transplantation of heterogeneous joint, knee arthroplasty with rotating hinge prosthesis, massive bone allograft ＋ knee arthroplasty with rotating hinge prosthesis, replantation of resected bone after devitalization, and half knee transplantation were performed. The patients were followed for more than two years postoperatively to record the survival in five years. The complications and material host reaction were observed, and the functional outcome was evaluated according to Mankin standards. RESULTS： Among the 39 patients with tibial malignant tumor, 10 cases died of general tumor metastasis 6 months to 2.2 years postoperatively, and 28 cases survived. The survival rate in 5 years was 74%. Among survivors, 4 cases underwent amputation due to local recurrence, while one was given tumor resection and bone allograft. The joint function was excellent in 20 cases, good in 8, fair in 6 and poor in 5. The satisfactory rate was 72%. CONCLUSION： It is better to adopt the best limb salvage ways to treat the malignant tumor in tibia according to tumor type and location. The effect of prosthesis combing with massive bone allograft is superior to replantation of resected bone after devitalization.