定制肿瘤型关节假体置换术治疗恶性骨肿瘤31例临床效果分析

Clinical analysis of 31 cases of customized tumor type prosthesis replacement for the treatment of malignant bone tumor

目的观察定制肿瘤型关节假体置换术治疗恶性骨肿瘤患者的临床效果。方法收集本院2011年1月至2016年5月收治的31例恶性骨肿瘤患者的临床资料,其中男19例,女12例,平均年龄43岁。采用定制肿瘤型关节假体、患者实施肿瘤广泛切除或根治性切除后置换保肢,并进行术前、术后的综合性治疗。结果患者治疗后4个月,采用MSTS保肢功能评判系统随访评价,优11例,良15例,中2例,差3例,优良率为83.8%。术后并发症发生率为19.3%。3例患者死亡,1例在术后5个月时出现大腿中段内侧复发行再次手术瘤体切除,1例在术后17个月因假体松动行翻修手术,1例在术后14个月时出现局部复发截肢。所有患者在随访期内均未发现定制肿瘤型关节假体断裂、关节强直。结论定制肿瘤型关节假体置换在保留肢体功能的同时,肢体匹配度及稳定性较好,是一种可供选择的较理想且安全性较高的保肢治疗骨肿瘤方案。

Objective To observe the clinical effect of treatment of patients with malignant bone tumor type custom-made tumor prosthesis replacement. Method This study collected from January 2011 to May 2016 during the clinical data of 31 cases of malignant bone tumor patients in our hospital. 19 cases were male, 12 were female, the average age of 43 years. After the tumor was extensively resected or radically resected, custom-made tumor prosthesis replacement was performed for reconstruction, simultaneously, neoadjuvant chemotherapy were used in treating the tumor according the pathology. Result 4 months after treatment, the MSTS salvage function evaluation system to evaluate the physical function of patients, 11 cases were excellent, 15 were good, 2 cases, 3 cases were poor. The overall excellent and good function was obtained in 83.8% of the patients and postoperative complication rate was 19.3%. One patient after surgery 16 months later died of lung metastasis, multiple metastases in one patient died after 7 months after whole body bone, one case after 5 mid thigh medial recurrent tumor resection surgery again, months in one case 17 months after loosening renovated, 1 patient had local recurrence 14 months after the amputation in time. At follow-up, all patients were not there prosthesis fracture, joint stiffness. Conclusion In patients with bone tumors before prosthesis replacement surgery, after giving a comprehensive treatment, to retain physical function, compared with other reconstruction methods, with weight-bearing physical activity early, rapid recovery, use of the advantages of a long, fully enhance the quality of life of patients. Application of tumor prosthesis can give a satisfactory functional outcome, which is an effect method in limb salvage treatment of malignant tumor in knee.