组配式半骨盆假体置换术后围术期康复干预对患肢功能的影响

INFLUENCE OF PERIOPERATIVE REHABILITATION TO THE AFFECTED LIMB'S FUNCTION AFTER IMPLANTING MODULAR HEMIPELVIC PROSTHESIS

目的探讨围术期康复治疗对骨盆恶性肿瘤半骨盆切除、组配式半骨盆+全髋关节置换术后的患肢功能的影响。方法 2004年9月—2007年5月采用半骨盆切除、组配式半骨盆假体+全髋关节置换术治疗骨盆恶性骨肿瘤8例。术后根据肿瘤切除范围、人工假体置换术后稳定性和骨盆髋周动力肌修复后的平衡程度,决定术后患肢体位、患髋活动范围、是否使用髋部支具,同时指导患者分阶段、渐进地进行患肢足踝、膝、髋关节的主被动训练,下床负重时间和步态调整。结果随访8～30个月,平均13个月。术后8个月患肢功能评定:优2例,良6例。ISOLS评分:15～26分,平均19.5分。结论①术后患者的合理体位和良好的支具保护能有效的防止髋关节早期脱位;②患肢各关节的分阶段有序的主动训练能提高骨盆和髋周肌肉肌力及其平衡度,对术后患者行走和步态有重要意义。

Objective To discuss the influence of perioperative rehabilitation to the affected limbs function after resection of malignant pelvic tumors and implant modular hemipelvic prosthesis plus total hip. Methods From September 2004 to May 2007, 8 patients of malignant pelvic tumors were treated with hemipelvic resection and implanted customed hemipelvic prosthesis combine total hip replacement. There were 4 chondrosarcoma, 2 liomyosarcoma, 1 osteosarcoma, 1 malignant giant cell tumor of bone. In this sutudy, 6 patients classified as stage Ⅰ B, 2 patients classified as stage Ⅱ B. The postoperative position of affected limb, the motion range of affected hip, and utilization of hip orthosis was determined by the area of resoction, stability of implant and equilibrium/balance degree after repairing pelvic periacetabular dynamic muscle. Meanwhile, the patients were instructed in phasic and progressive ways to exercise actively and passively the ankle,knee and hip joint of affected limb and to adjust gait and time of getting out of bed and weight bearing. Results The average follow- up is 13 months （range 8-30 months）. Eight months after operation, the function scores were excellent in 2 cases, good in 6 cases. Average ISOLS score was 19.5 （range 15-26）. Conclusion Reasonable postoperative position and favourable protection of orthosis can effectively avoid dislocation of the hip. Well- regulated active exercise of affected limb can increase muscle force and improve balance degree of pelvic and periacetabular muscles. It is also significantly for postoperative walking and gait of patients.