组合式半骨盆置换后康复干预8例报告

Treatment of postoperative rehabilitation after implanting modular hemipelvic prosthesis in 8 cases

选择2004-09/2007-05四川大学华西医院骨科采用半骨盆切除、组合式半骨盆假体+全髋关节置换治疗骨盆恶性骨肿瘤患者8例,其中软骨肉瘤4例,平滑肌肉瘤2例,骨肉瘤1例,恶性骨巨细胞瘤1例。外科分期:ⅠB期5例,ⅡB期3例。置换后根据肿瘤切除范围、人工假体置换术后稳定性和骨盆髋周动力肌修复后的平衡程度,决定置换后患肢体位、患髋活动范围、是否使用髋部支具,同时指导患者分阶段、渐进地进行患肢足踝、膝、髋关节的主被动训练,下床负重时间和步态调整。随访8～30个月,平均13个月。1例置换后16个月死于恶性肿瘤扩散转移,7例存活。置换后8个月患肢功能评定:优2例,良6例。国际保肢学会评分:15～26分,平均19.5分。组合式半骨盆假体+全髋关节置换后患者的合理体位和良好的支具保护能有效防止髋关节早期脱位,患肢各关节分阶段有序的主动训练能提高骨盆和髋周肌肉肌力及其平衡度,对患者行走和步态有重要意义。

From September 2004 to May 2007, 8 patients of malignant pelvic tumors were enrolled at West China Hospital, Sichuan University. They underwent hemipelvic resection and were implanted with customed hemipelvic prosthesis combining total hip replacement. There were 4 chondrosarcoma, 2 liomyosarcoma, 1 osteosarcoma, and 1 malignant giant cell tumor of bone. In this study, 5 patients were classified as stage Ⅰ B, while 3 patients as stage Ⅱ B. The postoperative position of affected limb, the motion range of affected hip, and utilization of hip orthosis were determined by the area of resection, stability of implant and balance extent after repairing pelvic periacetabular dynamic muscle. Meanwhile, the patients were instructed by phase and in progressive ways to exercise actively and passively the ankle, knee and hip joint of affected limb and to adjust gait and time of getting out of bed and weight bearing. The average follow-up was 13 months （range 8-30 months）. Sixteen months later, one patient died from tumor spread and metastasis. Seven patients survived. Eight months after operation, the function of affected limbs was evaluated： 2 patients were scored as excellent, and 6 good. Average score of International Society of Limb Salvage was 19.5 （range 15-26）. Reasonable postoperative position and favourable protection of orthosis can effectively avoid dislocation of the hip. Well-regulated active exercise of affected limb can increase muscle force and improve balance extent of pelvic and periacetabular muscles. It is also significant for postoperative walking and gait of patients.