骨干人工假体在股骨近端恶性肿瘤切除后骨缺损重建中的初步应用

The preliminary report of intercalary diaphyseal endoprosthetic reconstruction for the proximal femur malignant bone tumor

目的 探讨采用骨干人工假体对股骨近端骨干恶性肿瘤切除后结构性骨缺损进行重建的可行性.方法 2011年6月至2014年7月对7例股骨近端恶性骨肿瘤患者采用骨干人工假体置换,男3例,女4例;年龄28～76岁,平均61.8岁.原发恶性骨肿瘤4例,转移癌3例.术前常规行X线、CT及MR检查,通过MRI测量瘤段骨长度及软组织侵犯范围,再根据截骨长度选择骨干人工假体配件.取股骨近端外侧直切口,逐层切开皮肤、皮下组织,按肿瘤切除原则充分显露术前MRI测量的瘤段骨及软组织肿瘤并截骨,扩髓后安装骨干人工假体,依次缝合各层组织.术后切除组织送病理学检查.结果 手术时间45～120 min,平均90 min;术中出血量200～800 ml,平均400 ml.随访6～24个月,平均14个月.1例骨肉瘤患者术后1年因出现肺转移而死亡,3例原发恶性骨肿瘤患者术后未出现术区复发及远处转移.1例乳腺转移癌患者术前多发转移,术后行综合治疗,带瘤生存;2例乳腺转移癌患者随访期间未出现原位复发或转移.7例患者术后患肢髋关节功能均无受限.结论 使用骨干人工假体对股骨近端骨干恶性肿瘤切除后结构性骨缺损进行重建,保留了邻近的髋关节及肌腱附着点,操作简单,住院时间较短,可早期负重,是一种理想的治疗股骨近端骨肿瘤的保肢手术方法.

Objective To evaluate the clinical effectiveness of the treatment for the proximal femur malignant bone tumor by conducting intercalary diaphyseal endoprosthetic reconstruction.Methods Form June 2011 to July 2014,7 patients who had proximal femur malignant bone tumor were treated with intercalary diaphyseal endoprosthetic reconstruction.There were 3 males and 4 females,61.8 years old on the average （ranging from 28 to 76 years）.The tumors involved：4 case of the limbs primary malignant tumor,1 case of osteosarcoma,1 case of juxtacortical osteosarcoma,1 case of malignant lymphoma with pathological fracture,and 1 case of malignant fibrous histiocytoma with pathological fracture,as well as 3 cases of the Metastatic breast cancer of the proximal femur.All patients were evaluated by plain radiography,CT and MRI before operation.After these 7 patients were examined with MRI and the level of osteotomy was determined,prosthesis fitting is ready.The exposures of all the tumors were via the femur lateralis surgical approach.According to the general principles of tumor surgery,expose the tumor segment and soft tissue tumors.The segment of involved bone was then removed,with a surrounding cuff of normal tissue overlying the tumor.The level of osteotomy was determined as the result of preoperative imaging measurement.The proximal and distal femur intramedullary canals are reamed.The prosthesis is assembled and installed after the cement used.Results The duration of surgery was from 45 min to 120 min （90 min on average）.The blood loss was from 200 ml to 800 ml （400 ml on average）.All patients were followed-up for 6 months to 2 years （14 months on average）.1 case with osteosarcoma died due to pulmonary metastases 18 months after surgery.The remaining 3 cases with the primary malignant bone tumors did not recur or transfer during the follow-up period.1 case with the metastases was comprehensive treated in another hospital,and survival with tumors.The remaining 2 cases with the metastases did not recur or transfer during the follow-up period.Conclusion The clinical results demonstrated that the intercalary diaphyseal endoprosthetic reconstruction was an ideal treatment for the proximal femur malignant bone tumor.