双动型假体置换治疗股骨近段肿瘤的疗效评价

BIPOLAR PROSTHETIC REPLACEMENT FOR PROXIMAL FEMORAL TUMORS

目的从肿瘤预后、假体生存、功能以及手术并发症角度评价股骨近段肿瘤切除、双动型股骨近段假体置换的效果。方法 2001年7月-2010年7月,对96例股骨近段肿瘤患者行肿瘤切除、双动型股骨近段假体置换术。男50例,女46例;年龄15～69岁,平均43.2岁。其中股骨近段骨肿瘤83例,大腿软组织肉瘤累及股骨近段13例。85例采用股骨近段肿瘤型假体,11例使用灭活骨-人工假体复合物重建缺损。根据Enneking分期,ⅠA、ⅠB期以及良性病变24例为A组,ⅡA、ⅡB期56例为B组,Ⅲ期原发肿瘤、骨髓瘤、淋巴瘤16例为C组。术后下肢功能采用1993年美国骨肿瘤学会评分(MSTS93)系统进行评估。结果 93例患者术后切口Ⅰ期愈合;3例切口未愈,行清创后全部愈合。89例获随访,随访时间1～10年,中位时间6.5年。随访期间死亡28例,均死于肿瘤疾病。A组患者5年和10年累积生存率均为100%,B组分别为56.5%和41.5%,C组5年累积生存率为18.4%;各组间比较差异均有统计学意义(P<0.01)。假体的5年和10年累积生存率分别为74.4%和62.5%,高于B、C组患者的5年和10年累积生存率(P<0.01)。61例存活患者功能随访时间为1～10年,平均4.7年;末次随访时MSTS93评分为63%～95%,平均79%。15例(16.9%)出现术后并发症:2例髋关节脱位,2例假体迟发性感染,8例假体无菌性松动,1例髋臼严重磨损、股骨头向髋臼内上移位,2例髋部痛疼、行走困难。结论双动型股骨近段假体治疗股骨近段肿瘤可使患者获得良好功能,尤其适用于EnnekingⅡ、Ⅲ期及骨髓瘤和淋巴瘤患者;但后期可能因假体无菌性松动、髋臼磨损以及髋部疼痛而需行翻修。

Objective To evaluate the effectiveness of bipolar prosthetic replacement for proximal femoral tumors from the perspectives of patient survival, prosthesis survival, functional outcomes, and complication rates. Methods Between July 2001 and July 2010, 96 patients with proximal femoral tumors underwent wide resection and bipolar prosthetic replacement, including 83 cases of primary femoral tumors and 13 cases of soft tissue sarcomas involving the proximal femur. There were 50 male and 46 female patients with a mean age of 43.2 years （range, 15-69 years）. Prosthetic replacement for proximal femoral tumors was used in 85 patients and deactivated bone-prosthetic complex was used in 11 patients. According to Enneking staging, the patients were divided into 3 groups： group A, 24 patients at stages IA, IB, and benign lesion; group B, 56 patients at stages IIA and IIB; and group C, 16 patients at stage III, myeloma, and lymphoma. The American Musculoskeletal Tumor Society 1993 version （MSTS93） functional score was used to evaluate the lower limb function. Results Primary healing of incision was obtained in 93 patients; 3 patients had poor healing, which was cured after debridement. Of the patients, 89 were followed up 6.5 years on average （range, 1-10 years）. During follow-up, 28 patients died of tumor. The 5- and 10-year survival rates of patients were 100% in group A, and were 56.5% and 41.5% in group B respectively, and the 5-year survival rate was 18.4% in group C; there was significant difference among 3 groups （P 〈 0.01）. The 5- and 10-year survival rates of prosthesis were 74.4% and 62.5%, which were significantly higher than those of patients in groups B and C （P 〈 0.01）. Sixty-one patients were followed up 1-10 years （mean, 4.7 years） for functional evaluation. The mean MSTS93 score of the survival patients was 79% （range, 63%-95%） at last follow-up. Complications were observed in 15 patients （16.9%）： hip dislocation in 2, delayed infection in 2, aseptic loosening in 8, severe acetabulum wear in 1, and hip pain in 2. Conclusion Bipolar proximal femoral prosthetic replacement for proximal femoral tumors can provide a satisfactory functional outcome, especially for tumors at stage II or III and myeloma and lymphorma patients. Revision is needed because of main late complications of aseptic loosening, hip pain, and acetabulum wear.