人工关节假体复合大段同种异体骨移植重建肢体功能

Allograft prosthesis combination in limb salvage surgery

目的 探讨采用复合人工关节假体大段同种异体骨移植的方法治疗肢体恶性骨肿瘤的手术原理及效果。 方法 骨肿瘤患者 16例 ,年龄 19岁～ 60岁 ,其中骨肉瘤 4例 ,软骨肉瘤 2例 ,恶性骨巨细胞瘤 3例 ,纤维肉瘤 3例 ,其它恶性骨肿瘤 4例。肢体功能重建方法包括 :复合股骨近端的全髋关节置换术 3例 ,复合股骨近端的双极人工股骨头置换术 7例 ,复合股骨下端或胫骨上端的全膝关节置换 6例。 结果 本组 16例经 1 5～ 5 0年随访 ,1例死亡 ,12例无瘤存活 ,3例带瘤存活。多数患者术后获得了较好关节功能及生活质量。 结论 人工关节假体复合大段同种异体骨移植 ,适合恶性骨肿瘤肢体挽救术和保肢手术后的二次返修术 ,具有人工关节和大段同种骨移植双重优点 ,手术设计应注重生物力学原理和大段同种骨愈合特点。

Objective To study allograft prosthesis combination in limb salvage and the rational of composite prosthesis.Methods Of16 patients with bone tumors age from 19 to 60 years, 6 women 12 men, osteosarcoma was found in 4 patients, chondrosarcoma in 2, malignance giant cell tumor in 3, fibrosarcoma in 3, and other malignant bone tumor in 4. Allograft prosthesis combination in included allograft proximal femurs with tatal hip arthroplasty (3 patients), allografts bipolar femoral head replacement (8), allografts with toral knee arthoplasty prosthetic replacements (7). All patients received adjuvant therapy for tumor control. Results The length of follow up ranged from 18 months to 5 years during which time 1 patients died, 3 survived as tumor carriers, and 12 were disease free. All patients obtained better functional result in their extrmities and had good quality of life. Conclusions Both prosthetic replacement and allograft advantages, the use of large bone allografts with metallic protheses for the treatment of bone tumors near or involving joints can be applied with good results in selected patients having limb salvage surgery.