定制型肿瘤半肩关节的改良设计及应用

The Improvement and Application of Artificial Tumor Humeral Replacement

目的探讨人工肱骨头假体的改进及其在保肢术中的应用方法及临床效果.方法2009年1月至2011年6月,昆明医学院第三附属医院采用改良的人工假体置换治疗肱骨近端肿瘤8例,其中男6例,女2例;年龄14～48岁,中位年龄19.1岁.按ISOLS功能评价标准,得分18～22分,平均20.5分;恶性肿瘤及骨巨细胞瘤术前行1周期新辅助化疗.结果6例病例,术中瘤段截除6～14 cm,平均10.3 cm.随访5～20个月,平均13.2个月.5例骨肉瘤患者中,4例患者存活至今,1例于术后5月死于多器官功能衰竭;1例多发性骨髓瘤患者化疗后全身病情稳定,局部未见复发;良性肿瘤2例未见局部复发.所有患者术后拍片检查显示:骨-假体连接处对合良好,骨痂状态稳定;假体均无松动和断裂发生,加长垫无移位.按ISOLS功能评价标准,术后得分22～27分,平均24.4分.结论人工肱骨头假体的应用在临床可获得良好的关节功能,对假体的改良有助于加强假体的稳定性.

Objective To investigate the improvement of artificial humerus head and its application and clinic effect in limb salvage operation.Methods We treated 8 cases of proximal humerus tumor by improved artificial limb replacement,from Feb,2009 to May,2011.8 patients included 6 male and 2 female patients,aged 14～48 years old.All were evaluated according to ISOLS,18～22,20.5 on average.The malignant tumor and giant cell tumor of bone were treated by neoadjuvant chemotherapy about 1 weeks preoperatively.Results The tumor of all 6 cases were excised 6～14 cm,10.3 cm on average.All patients were followed up for 5～20 months,13.2 months on average.4 patients were still alive with malignant tumor in 5 patients with osteosarcoma,1 case died of MOF 5 monthes after operation.case of multiple myeloma was stable after chemotherapy without recurrence at local site.All benign tumor had no recurrence at local site.All cases took X ray diagnosis： bone replacement interface showed good contact to the adjoining and callus remained stable;The prosthesis showed no loosening and failure,extended pad no displacement;The functional measure was evaluated according to ISOLS that result was 22～27,24.4 on average postoperation.Conclusions The application of individualized artificial humerus head replacement has been more and more mature in clinic orthopaedics.The replacement could really take the place of natural mature bone and get good joint function and basic stability.Modification of the artificial joint replacement can strengthen the stability of replacement.