用双极股骨头半髋关节重建治疗股骨近端骨肉瘤的疗效评价

Clinical effects of bipolar hemiarthroplasty in the treatment of proximal femoral osteosarcoma

目的探讨双极股骨头半髋关节(bipolar hemiarthroplasty,BHA)重建治疗股骨近端骨肉瘤的疗效。方法选自2012年1月至2016年1月间我中心收治的25例(男15例,女10例)股骨近端骨肉瘤患者,随机分为A、B两组,A组接受双极股骨头半髋关节假体重建,B组接受全髋关节(total hip arthroplasty,THA)重建术。术后随访用MSTS、Harris量表评估对照两组关节功能、转移率和生存率。结果术后34.4个月随访结果显示A组生存率为84.6%,3例发生肺部转移,2例死亡,没有发生骨盆转移或局部复发。随访时Harris评分平均为(76.0±3.6)分,疼痛视觉模拟评分(visual analogue scale,VAS)平均为1.77分,屈髋度数为(96.5±9.5)°。MSTS平均为27.5分。满意率为90%。B组生存率为83.3%,2例发生肺部转移后死亡,5例发生骨盆转移。随访时Harris评分平均为(72.40±6.34)分(P>0.05),VAS平均为2.8分,屈髋度数为(94.1±15.1)°。MSTS平均为27.25分。满意率为80%。结论 A组在术后2年内的骨盆转移率明显低于对照组,其余髋关节功能及生存率差异无统计学意义。提示全髋假体重建手术中打磨髋臼时可能会造成肿瘤细胞的种植转移。建议进行半髋关节重建术,再根据需要进行二期全髋关节翻修术。

Objective Osteosarcoma, commonly located at the proximal femur, is one of the most common malignant bone tumors. Reconstruction of the hip joint with total hip arthroplasty after wide resection of tumors is the most popular way of limb-salvage surgery. We noticed that tumors were inclined to transfer to regions near the acetabulum. We presumed that localized metastasis was caused by acetabulum reaming which would break the biological parclose of the cartilage during total hip arthroplasty(THA）. Methods We retrospectively studied 25 patients(Male 15, Female 10） of proximal femoral osteosarcoma from Jan, 2012 to Jan, 2016. All were randomly divided into 2 groups： Group A, reconstruction with bipolar hemiarthroplasty(BHA）; Group B, reconstruction with THA. MSTS score, Harris scale, ROM of the hip, metastasis rate and survival rate were evaluated after surgery. Results All patients were followed up for 34.4 months. Group A： survival rate 84.6%; 3 patients had lung metastasis and 2 of them died; no pelvic metastasis or local recurrence was observed; the average Harris score was(76.0 ± 3.6）; the average VAS was 1.77; ROM of the hip was(96.5 ± 9.5） °; the average MSTS score was 27.5/30 with satisfaction rate 90%. Group B： survival rate 83.3%; 2 patients had lung metastasis and both of them died; 5 patients had metastatic lesions on the pelvic; the average Harris score was(72.40 ± 6.34）(P 0.05）, the average VAS was 2.8; ROM of the hip was(94.1 ± 15.1） °, the average MSTS score was 27.25/30 with satisfaction rate 80%. Conclusions Incidence of pelvic metastasis of Group A is obviously lower than that of the Group B, while the joint function and survival rate are similar in both groups. It is suggested that acetabulum reaming may lead to local metastasis. We suggest to reconstruct the hip joint with BHA, and revise with THA as late as possible if necessary.