同种异体半髁或半平台重建邻近膝关节肿瘤切除后骨缺损的疗效分析

Effects of reconstruction with unicondylar osteoarticular allografts with or without prosthesis for bone tumors around knee joint

目的探讨同种异体半髁或半平台移植重建邻近膝关节肿瘤切除后骨缺损的临床效果。方法2007年1月至2015年12月共22例累及股骨半髁或胫骨半侧平台的骨原发恶性肿瘤（12例）和良性侵袭性肿瘤（10例）患者在第四军医大学附属西京医院骨科接受洽疗,男性14例．女性8例，年龄8～65岁，平均35岁。其中累及股骨半髁14例，累及胫骨半侧平台8例。在计算机导航辅助下按照术前设计的安全边界进行截骨，选择经数字骨库匹配好的异体骨，股骨侧采用异体半髁复合人工半髁假体重建，胫骨侧采用异体半平台重建。随访时间5～116个月，中位随访时间60个月。采用美国骨肿瘤学会功能评分（MSTS）和国际保肢协会（ISOLS）影像学评分评价术后关节功能．并记录相关并发症。结果12例恶性肿瘤患者中2例局部复发，行截肢手术，保肢率为83％；3例发生肺转移，其中1例死亡，2例带瘤存活；9例无瘤生存。Kaplan—Meier生存分析结果显示．5年无病生存率为73％。10例良性侵袭性肿瘤无局部复发和肺转移。末次随访时MSTS平均为26分，ISOLS影像学评价为78％-94％，平均90％。术后发生浅表感染1例、内固定螺钉断裂1例。14例股骨髁部肿瘤重建术后未发现异体骨塌陷、骨折；8例胫骨肿瘤患者重建术后6例出现异体骨塌陷、骨折。结论同种异体半髁复合人工半髁假体是股骨远端半髁肿瘤切除后重建的可行方案，可防止异体骨骨折和关节退变；对于胫骨近端局限于半侧平台内的肿瘤，异体半平台可以重建切除后骨缺损。

Objective To investigate the survival rate, function outcomes, and complications after using unicondylar osteoarticular allografts with or without prosthesis to reconstruct the knee joint for tumors located in distal femoral or proximal tibial uni-eondyle. Methods Twenty-two patients who underwent unicondylar osteoartieular allografts with or without prosthesis composite reconstructions from January 2007 to December 2015 in Department of Orthopaedic Surgery of Xi Jing Hospital, the Fourth Military Medical University were retrospectively reviewed. There were 14 males and 8 females and the mean age was 35 years （8-65 years）. There were 12 malignent tumors and 10 aggressive benign tumors. The tumors were located in distal femur in 14 cases and proximal tibia in 8 cases. After tumor excision, the distal femur was reconstructed with unicondylar osteoallograft-prosthesis composite, and proximal tibial plate was reconstructed with unicondylar osteoarticular allograft with the help of computer-assisted navigation system. Function and radiograph were documented according to the Musculoskeletal Tumor Society （MSTS） functional scoring system and the International Society of Limb Salvage （ISOLS） radiographic scoring system. The median follow-up time was 60 months （5- 116 months ）. Results At the latest follow-up, 2 patients had amputation owing to local recurrence in 12 malignant tumors. Three patients had pulmonary metastasis and 1 patient died another 2 alive with disease. Kaplan-Meier analysis indicated that the disease- free survival rate was 73%. There was no recurrence and metastasis in 10 patients with giant cell tumor. The average MSTS score was 26 points and the radiographic score was 78%- 94% （average 90%）. The complications included superficial infection in 1 patient and screw broken in 1 patient. There was no broken or collapse allograft in all composite reconstruction patients but 6 cases in allograft reconstruction. Conclusions Unicondylar osteoarticular allografts or prosthesis composite was feasible reconstruction for tumors in distal femoral uni-condyle. It could provide good functional outcomes and also prevent joint degeneration. Similarly, allograft reconstruction was also a reliable technique for proximal tibial defect.