交锁髓内钉在骨肿瘤术后功能重建中的应用

The application of intramedullary interlocking nail in the function restoration after bone tumor resection

目的探讨应用交锁髓内钉进行骨肿瘤术后功能重建的方法和疗效。方法 29例患者,男14例,女15例。年龄21～73岁,平均35.5岁。其中骨囊肿病理性骨折4例,骨纤维异常增殖症病理性骨折1例,非骨化性纤维瘤病理性骨折1例,骨转移癌病理性骨折8例,骨转移癌未骨折4例,骨肉瘤11例。病变位于肱骨3例,胫骨2例,股骨24例。采取切开复位交锁髓内钉固定14例,瘤段切除灭活再植交锁髓内钉固定9例,瘤段切除异体半关节移植交锁髓内钉固定2例,预防性交锁髓内钉内固定4例。结果随访12～48个月,切开复位内固定14例中,骨转移癌8例,术后死亡5例,1例术后肿瘤范围扩大,余2例基本恢复到骨折前功能状况,6例良性患者,术后无肿瘤复发,骨折均愈合;瘤段切除灭活再植9例中,术后死亡2例,肿瘤复发1例,截骨不愈合1例,余5例愈合;瘤段切除异体半关节移植2例中1例愈合,1例不愈合。4例预防性内固定中,1例术后1年内死亡,余3例术后功能良好。结论交锁髓内钉在病理骨折内固定,自体骨灭活再植及异体骨移植重建中具有对位容易,固定可靠,可早期功能锻炼等优点,应用骨转移癌预防性内固定可有效避免病理骨折的发生。

Objective To evaluate the application of intramedullary interlocking nail in the functional restoration after bone tumor resection. Methods A total of 29 patitents （14 men and 15 women） were involved. Their mean age was 35.5, ranged from 21 to 73. Four patients sustained pathological fracture caused by bone cyst; 1 sustained pathological fracture caused by bone-fibrous dysplasia; 1 sustained pathological fracture caused by non-ossifying fibroma; 8 sustained pathological fracture caused by hone metastases; 4 did not sustain pathological fracture caused by hone metastases; and 11 sustained osteosarcoma. The lesion was at the humerus （n=3）, the tibia （n=2）, and the femur （n=24）. Fourteen patients underwent open reduction and intramedullary interlocking nail fixation; 9 underwent tumor segmental resection and inactivation followed by intramedullary interlocking nail fixation; 2 underwent tumor segmental resection and hemi-articular allograft transplantation followed by intramedullary interlocking nail fixation; and 4 underwent preventive intramedullary interlocking nail fixation. Results After the follow-up of 12 to 48 months, among the 14 patients who underwent open reduction, 8 sustained bone metastases, 5 died and 1 sustained expanded tumor range. Two of the other patients almost regained function. No relapse occurred in the 6 patients who had benign tumor, and their fractures all healed. One of the 2 patients who underwent tumor segmental resection and hemi-articular allograft transplantation followed by intrameduUary interlocking nail fixation recovered, and the other did not. Among the 4 patients who underwent preventive intramedullary interlocking nail fixation, 1 died within 1 year after surgery, but the other 3 regained good function. Conclusions In treating pathological fracture, devitalized bone replantation and allograft transplantation, intramedullary interlocking nail has the following advantages： easy contraposition, stable fixation, and early exercise. The bone metastases preventive internal fixation can avoid the occurrence of pathological fracture.