人工关节在骨肿瘤保肢治疗中的应用

The application of prosthetic replacement in limb salvage treatment of patients with bone tumors

目的 探讨人工假体在骨肿瘤保肢术中的应用价值。方法 分析 50例骨肿瘤患者进行人工假体置换术后的效果、生存情况、功能、并发症及处理。肿瘤类型 :恶性肿瘤 22例，其中骨肉瘤 11例，软骨肉瘤 5例，恶性纤维组织细胞瘤 2例，恶性骨母细胞瘤、腺泡状肉瘤、横纹肌肉瘤、骨巨细胞肉瘤各 1例；良性肿瘤 28例，其中骨巨细胞瘤 27例，良性纤维组织细胞瘤 1例。肿瘤部位 :股骨远端 24例，股骨近端 7例，股骨干 2例，胫骨近端 7例，肱骨近端 7例，肱骨远端 2例，肩胛骨 1例。假体类型 :铰链式膝关节 26例，股骨近端假体 7例，生物固定式胫骨近端假体 7例，肱骨近端假体 7例，铰链式肘关节 2例，人工肩胛骨 1例。结果 22例恶性骨肿瘤 :局部复发率为 18.1％，五年生存率为 38.8％，最终保肢率为 81.9％，未见假体并发症。 27例骨巨细胞瘤 :复发率及死亡率均为 3.7％，并发症发生率为 40.7％，最终保肢率为 84.8％。 1例肩胛骨良性纤维组织细胞瘤术后 16年功能良好。在所有关节中，生物固定式胫骨上端假体、铰链式肘关节、人工肱骨头功能较好，人工股骨头功能稍差，铰链式膝关节功能最差，并发症高。结论 人工假体置换术可用于恶性及侵袭性骨肿瘤的保肢治疗，但应进一步改进假体的设计、固定及软组织重建，以减少?

Objective To evaluate the application of prosthetic replacement in limb salvage treatment of bone tumors. Methods 50 patients with bone tumors treated with en bloc resection and prosthetic replacement were reviewed. Their survivorship, limb function, complication and the management were analysed. There were 22 malignant tumors including 11 osteosarcomas, 5 chondrosarcomas, 2 malignant fibrous histocytomas, and one each of malignant osteoblastoma， alveolar sarcoma， rhabdomyosarcoma， malignant giant cell tumor of bone. 28 benign tumors included 27 giant cell tumors of bone and 1 benign fibrous histocytoma. The types of the prostheses were as follows: 26 hinged knee prostheses, 7 proximal femoral prostheses, 7 proximal tibial biofixation prosthesis, 7 proximal humeral prostheses, 2 hinged elbow, 1 artificial scapula. Results In the patients with malignant bone tumors, local recurrence was seen in 18.1％ ; the 5－ year survival rate were 38.8％ , final limb salvage rate was 81.9％ . No prosthesis related complications were seen. In patients with giant cell tumor of bone, the rate of local recurrence and mortality were 3.7％ ; complications occurred in 40.7％ of the patients, and the final limb salvage rate was 84.8％ . 1 patient with benign fibrous histocytoma in scapula has survived 16 years with good function. In all of the prostheses, the function of the proximal tibial biofixation prosthesis, proximal humeral prostheses, hinged elbow and artificial scapula were better than others, then followed by proximal femoral prostheses; the hinged knee had the highest rate of complications. Conclusion Prosthetic replacement can be used in the limb salvage surgery of patients with malignant or aggressive benign bone tumors; further improvements in design, fixation and soft tissue reconstruction technique of the prostheses are needed for reducing the complications.