股骨远端恶性肿瘤术后肿瘤学预后及假体生存分析

Analysis of oncological prognosis and survival of prosthesis after surgery for distal femoral malignant tumors

目的探讨股骨远端恶性骨肿瘤患者保肢术后的肿瘤学预后、假体的生存率及相关影响因素。方法回顾性分析山西医科大学第二医院2008年1月至2013年12月收治的42例股骨远端恶性骨肿瘤行瘤段切除、膝关节肿瘤假体置换术患者的临床资料。对患者的肿瘤学预后、假体生存率及相关影响因素进行分析。结果随访时间18~97个月。42例恶性骨肿瘤患者中,无瘤生存21例(50%),带瘤生存7例(16%),5年总生存率为66%。其中EnnekingⅡB期患者的5年总生存率为55.4%,ⅡA期患者的5年总生存率为75.0%,两者差异有统计学意义(χ2=4.350,P=0.037)。人工假体生存率为78.6%(22/28),不同的截骨长度影响假体的生存率(χ2=4.248,P=0.039),不同的假体种类不影响假体的生存率(χ2=2.177,P=0.140)。结论股骨远端恶性骨肿瘤患者保肢术后具有较好的肿瘤学预后,影响肿瘤预后的重要因素是肿瘤Enneking分期。股骨远端不同的截骨长度影响假体的生存率,截骨的长度越长假体的生存率越低。

Objective To investigate the oncological prognosis, prosthesis survival rate and other related factors after limb salvage surgery for distal femoral malignant bone tumors. Methods A total of 42 patients who received the surgery of resection of malignant bone tumor of distal femur and prosthesis replacement of knee joint tumor in the Second Hospital of Shanxi Medical University from January 2008 to December 2013 were retrospectively analyzed. The patient's oncological prognosis, prosthesis survival rate and related influencing factors were analyzed. Results The follow-up period was 18-97 months. Of 42 patients with malignant bone tumors, 21 cases (50%) survived without tumor, 7 cases (16%) survived with tumor, and the 5-year overall survival rate was 66%. The overall survival rate of patients with Enneking stage ⅡB tumor was 55.4%, and that of patients with stage ⅡA tumor was 75.0%, and the difference was statistically significant (χ 2=4.350, P=0.037). The survival rate of artificial prosthesis was 78.6%(22/28), the different length of osteotomy affected the survival rate of prosthesis (χ 2=4.248, P=0.039), but the different types of prosthesis did not affect the survival rate of prosthesis (χ 2=2.177, P=0.140). Conclusions The distal femoral malignant bone tumor has a good oncological prognosis after limb salvage surgery, Enneking staging is an important factor affecting the oncological prognosis. The different length of osteotomy at the distal femur affects the survival rate of the prosthesis, the longer the prosthesis, the lower the survival rate of the prosthesis.