组合式半骨盆置换术后早期康复护理对患肢功能的影响

Effect of Affected Limb's Function Caused by Postoperative Early Rehabilitative Nursing after Implanting Modular Hemipelvic Prosthesis

目的：探讨术后早期康复护理干预对骨盆恶性肿瘤半骨盆切除、组合式半骨盆＋全髋关节置换术后的患肢功能的影响。方法：从2004年9月至2007年5月采用半骨盆切除、组合式半骨盆假体＋全髋关节置换术治疗骨盆恶性骨肿瘤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6例，ⅡB期2例。术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，决定术后患肢体位、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，以及下床负重时间和步态调整。结果：随访10～32个月，平均15月。1例术后16个月死于恶性肿瘤扩散转移，7例存活。术后8个月患肢功能评定：优2例，良6例。ISOI。S评分：15～26分，平均19．47分。结论：①对骨盆恶性骨肿瘤患者积极进行术后早期康复护理干预能有效的防止人工髋关节早期脱位；②患肢各关节分阶段有序的主动康复护理训练能提高骨盆和髋周肌肉肌力及其平衡度，对维持术后患者行走和步态的稳定有重要意义。

Objective：To discuss the influence of the affected limb＇s function caused by postoperative early rehabilitative nursing after resection of malignant pelvic tumors and replacement of modular hemipelvic prosthesis including total hip. Methods：From September 2004 to May 2007, in 8 patients with malignant pelvic tumors, hemipelvic resection and implantation specially designed combinational heterotype hemipelvic prosthesis including total hip was done. Among them,there are 4 cases of chondrosarcoma, 2 cases of liomyosarcoma, 1 case of osteosarcoma, 1 case of malignant giant cell tumor of bone. In this series, 6 patients were classified as stage I B, 2 patients were classified as stage II B. Postoper- atively, the body position of affected limb, the orbit of affected hip,and utilization of hip orthosis was determined accord- ing to the area of resection, stability of implantation hemipelvic prosthesis and equilibrium degree after recovering pelvic periacetahular dynamo muscle. At the same time,the patients were instructed in phasic and progressive ways to exercise actively and passively the ankle,the knee and the hip joint of affected limb and to adjust gait and time of getting out of bed and weight loading. Results： The follow-up ranged from 10~32 months, median 15 months. One patients died of tumor extension and metastasis in 16 months after the operation, 7 patients were alive. Eight months after operation,the results of postoperative functional score were 2 excellent, 4 good, 2 fair. ISOLS score was from 15--26, median 19.47. Conclusion First, the early rehabilitative nursing for the malignant pelvic tumors patients can effectively avoid dislocation of the artificial hip. Second, it is significantly for postoperative walking and gait of patients that phasic, order and active rehabilitative nursing of every joint of affected limb can increase the muscle strength and improve the balance degree of pelvic and periacetabular muscles.