骨肿瘤人工关节保肢术后继发截肢的回顾性研究

Retrospective study on the secondary amputation after the limb salvage surgery for bone tumor

背景:人工关节置换术是骨肿瘤切除术后骨缺损的主要重建方法,目前有关骨肿瘤患者接受人工关节保肢术后继发截肢的报导较少。目的:分析骨肿瘤患者接受人工关节保肢术后继发截肢的风险因素。方法:随访1995年10月至2011年10月接受人工关节保肢治疗的骨肿瘤患者1459例。收集包括病史、诊断、治疗过程、术后并发症情况、转归等临床资料,并对上述资料进行相关的统计学分析。结果:1459例中70例保肢失败而接受二期截肢手术,继发截肢率为4.80%。截肢手术的原因包括肿瘤局部复发54例;人工关节周围深部感染14例;保肢术后肢体远端急性缺血坏死2例。人工关节保肢术距离截肢手术的时间为6d至122个月,平均18.1个月。结论:人工关节保肢术可有效重建骨肿瘤患者的骨缺损,其远期并发症较少,但仍有保肢失败继发截肢的风险。肿瘤局部复发和深部感染是继发截肢的主要因素。病理性骨折是肢体肿瘤患者接受人工关节保肢术后继发截肢的重要危险因素。降低人工关节保肢术后局部复发和深部感染的发生率可有效降低继发截肢的风险。继发截肢的风险随保肢术距离截肢手术的时间间隔延长而逐渐降低。

Background：Endoprosthetic replacement is a main technique for reconstructing the bone defects after the bone tumor resection.So far,secondary amputations happened after the limb salvage surgery are rarely reported.Objective：To analyze the risk factors of amputation after the patients with bone tumor receive the limb salvage surgery.Methods：From October 1995 to October 2011,1459 patients with bone tumor received the limb salvage surgery and were followed up.The clinical data of medical history,diagnostic and treatment process,postoperative complications,and prognosis were collected and analyzed statistically.Results：70 out of 1459 patients failed the limb salvage surgery and received the secondary amputation surgery,the rate of the secondary amputation was 4.80%.Reasons for the amputation included 54 cases of local recurrence,14 cases of deep infection around the artificial joints,and 2 cases of acute ischemia and necrosis at the distal limb after the limb salvage surgery.The amputation surgery was performed after 6 days to 10 years after the limb salvage surgery,with an average of 18.1 months.Conclusions：The limb salvage surgery can effectively reconstruct the bone defects of patients with bone tumors.There are few long-term complications of it,however,there still exists the risk of secondary amputation following the failure of that surgery.Local recurrence and deep infections are the main causes of the secondary amputation.Pathologic fracture is an important risk factor of secondary amputation to the patients with limb tumors receiving limb salvage surgeries.An improved method of preventing the local recurrence and deep infection will effectively reduce the risk of secondary amputation.The risk of secondary amputation decreases with time.