瘤段切除肿瘤假体置换术联合人工补片技术治疗胫骨近端骨肉瘤对膝关节功能及预后的影响研究

Research of influence of knee joint function and prognosis after segmental resection for proximal tibia osteosarcoma with prosthesis replacement combined with artificial mesh

目的研究瘤段切除肿瘤假体置换术联合人工补片技术治疗胫骨近端骨肉瘤对膝关节功能及预后的影响。方法将80例胫骨近端骨肉瘤患者按手术方式不同分为对照组(n=38)和观察组(n=42),对照组接受瘤段切除肿瘤假体置换术,观察组接受瘤段切除肿瘤假体置换术联合人工补片技术。观察两组患者膝关节功能评分及主动背伸角度,比较两组术后复发率、生存率、并发症发生率及患者满意度。结果治疗前两组患者疼痛评分、活动范围评分、步行能力评分、日常功能评分及膝关节主动背伸角度比较,差异均无统计学意义(P﹥0.05);治疗后观察组患者疼痛评分、活动范围评分、步行能力评分、日常功能评分及膝关节主动背伸角度均明显优于对照组,差异均有统计学意义(P﹤0.01)。术后6个月,两组患者局部复发率及生存率比较,差异均无统计学意义(P﹥0.05)。观察组患者并发症总发生率为26.19%,低于对照组的57.89%,差异有统计学意义(P﹤0.05)。观察组患者总满意度为83.33%(35/42),高于对照组的57.89%(22/38),差异有统计学意义(P﹤0.05)。结论瘤段切除肿瘤假体置换术联合人工补片技术治疗胫骨近端骨肉瘤优于单纯瘤段切除肿瘤假体置换术,能够有效改善膝关节功能,降低并发症发生率,提高患者满意度,是一种安全有效的治疗方式,值得临床推广。

Objective To study the change of knee joint function and prognosis after segmental resection for proximal tibia osteosarcoma with prosthesis replacement combined with artificial mesh.Method Eighty patients of proximal tibial osteosarcoma were included in the research as control group(n=38)and study group(n=42)according to different surgical methods,the patients in control group received segmental resection with prosthesis replacement,and the study group were treated with segmental resection with prosthesis replacement combined with artificial mesh.The knee function score and the maximum angle of active ankle dorsiflexion of the two groups were observed,the postoperative recurrence rate,survival rate,incidence of complication and patients’degree of satisfaction of the two groups were compared.Result Before treatment,the pain,range of motion,walking ability,activities of daily living score and angle of active ankle dorsiflexion in study group were similar to those in control group(P>0.05);after treatment,the pain,range of motion,walking ability,activities of daily living score and angle of active ankle dorsiflexion in study group were significantly better compared to control group,with statistically significant differences noted(P<0.01).In 6 months after surgery,no significant difference regarding local recurrence rate and survival rate were observed between the two groups(P>0.05).The overall incidence of complications in the study group was 26.19%,which was significantly lower than the 57.89%in control group(P<0.05).The overall degree of satisfaction in study group was 83.33%(35/42),and was higher than that of the control group at 57.89%(22/38),showing statistically significant difference(P<0.05).Conclusion Segmental resection with prosthesis replacement combined artificial mesh for the proximal tibial osteosarcoma is superior to segmental resection with prosthesis replacement,and it may effectively improve the knee joint function,and reduce postoperative recurrence rate,with increased satisfaction level,thus it is a safe and effective surgical option.