四肢恶性骨肿瘤保肢治疗的软组织修复及功能重建

Soft tissue repairing and functional reconstruction in limb salvage operation on extremity bone malignant tumors

目的:探讨在新辅助化疗的帮助下,恶性骨肿瘤切除后,采用人工特制假体进行保肢治疗的疗效以及软组织修复和功能重建的重要性。方法:恶性骨肿瘤患者78例,其中男42例,女36例;年龄19～61(29.12±9.47)岁。位于肱骨近端者14例,股骨近端11例,股骨远端27例,股骨中段3例,胫骨近段23例。成骨肉瘤29例,软骨肉瘤18例,潜在恶性内生软骨瘤伴有病理性骨折7例,恶性骨巨细胞瘤20例,恶性炎症性肌纤维母细胞瘤4例。采用人工特制假体修复肿瘤切除后的骨缺损,同时行软组织修复和功能重建。其中14例定制加长柄的人工肱骨头,50例定制带股骨(或胫骨)铰链式膝关节,3例行全股骨置换,7例行加长柄人工股骨头置换,4例行加长柄全髋置换。结果:本组78例患者术后均获随访且均存活,随访时间4～37(26.80±8.06)个月。按Enneking肢体肌肉骨骼肿瘤外科治疗重建术后功能评估标准进行评估。本组术后功能评估为优的有48例(61.5%),良17例(21.8%),中10例(12.8%),差3例(4.9%),优良率达83.3%。结论:采用人工特制假体对四肢恶性骨肿瘤行有效的组织修复和功能重建,不但可以保留肢体,且保留的肢体具有良好的功能,也解除了患者因为肢体的缺失带来的心理障碍,是四肢恶性骨肿瘤有效的治疗方法。

Objective To investigate the effect and the significance of soft tissue repairing and functional reconstruction in limb salvage operation on extremity malignant bone tumors by individulized prosthesis replacement after malignant tumor resection with the help of Neo-adjuvant chemo-therapy.Methods A total of 78 patients with malignant bone tumor were recruited,including 42 males and 36 females.Aged 19~61,with an average of（29.12±9.47）.Tumor in 14 patients was in the proximal humerus,11 in the proximal femur,27 in the distal femur,3 in femoral middle part,and 23 in the proximal tibial.There were 29 cases of osteogenic sarcoma,18 chondroma sarcomatosum,7 maligant enchondroma with pathological fracture,20 maligant giant cell tumor,and 4 maligant inflammatory myofibroblastoma of the bone.Soft tissue repairing and functional reconstruction were carried out together with individualized prosthesis replacement.The type of the prostheses was as follows：14 patients had long stem humerus head prosthesis,50 made hinged knee prostheses with femoral or tibial component,3 whole femur replacements,7 long stem femoral head prostheses,4 long stem hip prostheses.Results All patients were followed up for an average of（26.80±8.06）months（4~37 months）and postoperative functions were estimated according to Enneking system.Among the 78 patients,results in 48（61.5%）were excellent,17（21.8%）were good,10（12.8%）were fair,and 3（4.9%）were poor.The satisfactory rate was 83.3%.Conclusion Soft tissue repairing and functional reconstruction in limb salvage operation on extremity bone malignant tumors by individualized prosthesis replacement not only spare the limbs,but also keep their function.It can remove the psychologic obstacles caused by extremity absence,and is effective for bone malignant tumor.