特制型人工膝关节假体置换治疗股骨远端骨巨细胞瘤12例

Custom-made Artificial Total Knee Prosthesis Replacement for Pathological Fracture of Distal Femur Caused by Giant Cell Tumor of Bone

目的:探讨利用特制型人工膝假体置换治疗股骨远端骨巨细胞瘤并病理性骨折的手术方法及效果。方法:12例12膝股骨远端骨巨细胞瘤并病理性骨折患者,采用特制型人工膝假体置换术进行治疗。其中男5例,女7例;平均年龄为34.2岁(23～40岁)。结果:所有患者均能较好的耐受手术。手术时间为120～180min,出血量为500～900mL,未出现血管、神经损伤等严重并发症。所有患者在术后5天内拔除引流管,术后引流量为300～700mL,平均450mL。术后病理学检查均为骨巨细胞瘤。术后复查X线片显示所有内固定物位置均良好。患者术后局部疼痛症状消失,无患者出现下肢深静脉血栓形成。所有患者均得到随访,随访时间18～30个月,平均24个月。随访中无一例出现切口感染和窦道形成。肿瘤无复发。内固定位置良好,假体无松动。末次随访中,患者Enneking评分为15～28分,平均23.8分,其中≥18分为11例,优良率占92%。结论:采用特制型人工膝关节假体置换治疗股骨远端骨巨细胞瘤并病理性骨折,具有效果良好,肿瘤切除彻底,不易复发,患者能够早期开始正常生活等优点,值得推广。

Objective： To evaluate the effect of custom-made artificial total knee prosthesis replacement on pathological fracture of distal femur caused by giant cell tumor of bone. Methods： A total of 12 knees of 12 patients with pathological fracture of distal femur caused by giant cell tumor of bone were treated with custom-made artificial total knee prosthesis replacement. There were 5 males and 7 females aged from 23 to 40 years （34.2 years on average）. Results： All patients tolerated surgery very well. The surgical duration was 120- 180 min and the intraoperative bleeding was 500-900mL. The drainage tube was taken out in 5 days after surgery. The postoperative drainage volume was 300-700mL. There were no postoperative complications. The postoperative X-ray examination showed that all of the prosthesises were in the right position. Local pain disappeared in all patients after surgery. The pathological examination identified all the patients with giant cell tumor of bone. All patients were followed up for 18- 30 months （24 months on average）. No recurrence was observed after surgery. No infection or implant loosening occurred during the follow up. According to the Enneking assessment system of function after limb salvage surgery, the mean Enneking scale was 23.8 points （ranged from 15 to 28 points） at the last follow-up visit. Conclusion： Custom-made artificial total knee prosthesis replacement can achieve a high satisfactory rate in clearance of lesion and restoring function of the knee in patients with pathological fracture of distal femur caused by giant cell tumor of bone, improving patients＇ quality of life.