人工假体置换在股骨下段骨肉瘤合并病理性骨折保肢治疗中的应用

Application of artificial total knee prosthesis replacement in limb salvage surgery for osteosarcoma with pathological fracture located in the distal femur

背景:骨肉瘤的传统治疗以截肢手术为首选,随着化疗方案的不断改进,以及人工关节假体制作工艺和材料学的进步使保留肢体功能成为可能。目的:观察人工肿瘤假体在股骨下端骨肉瘤合并病理性骨折者保肢术中的临床应用效果。方法:对9例股骨下端骨肉瘤合并病理性骨折患者行肿瘤段广泛性切除或根治性切除,然后进行人工膝关节假体置换重建膝关节,置换前后均行新辅助化疗。结果与结论:9例均获得随访,随访6～72个月。无瘤3年生存者8例,无瘤5年生存者6例,5年总生存率为66.7%。其中6例患肢屈伸活动均可达到0°～100°,3例患肢屈伸活动为0°～70°。根据Enneking功能评定标准进行功能评估:优6例,良2例,可1例。随访未见与材料有关的炎症和排异反应。结果说明该人工肿瘤假体置换后能重建膝关节结构,使膝关节功能达到较好的恢复,取得较好的治疗效果。

BACKGROUND：Amputation surgery as a traditional treatment for osteosarcoma is preferred.With the continuous improvement of chemotherapy,prosthesis manufacturing process and materials science advances,it is possible to keep body functions OBJECTIVE：To evaluate the effect of artificial total knee prosthesis replacement in the treatment of patients with osteosarcoma and pathological fracture located in the distal femur.METHODS：Limb salvage surgery with prosthetic knee replacement was performed in 9 patients with osteosarcoma and pathological fracture in the distal femur.The reconstruction of limb function was done using total knee replacement with individualized prosthesis.Neoadjuvant chemotherapy was used in all the cases pre- and postoperatively.RESULTS AND CONCLUSION：The nine patients were followed up for 6-72 months.Eight cases survived without tumor in 3 years and 6 in 5 years.The 5 years survive rate was 66.7%.The range of extension and flexion of the knee was 0°-100° in 6 cases,and 3 in 0°-70°.The function of the knee was assessed by Enneking system.The results were graded as excellent in 6 patients,good in 2 cases,and fair in 1 case.Material-related inflammation and rejection reactions were not found.It is effective for the treatment of osteosarcoma and pathological fracture in the distal femur through extensive or radical resection and reconstruction by using prosthetic knee replacement.