人工髋关节置换治疗股骨近端骨肿瘤疗效及预后影响因素研究

Curative effect of artificial hip replacement in the treatment of proximal femoral bone tumors and influencing factors of the prognosis

目的:探讨人工髋关节置换治疗股骨近端骨肿瘤的疗效及预后影响因素。方法:收集行人工髋关节置换术的股骨近端骨肿瘤患者75例,评价其疗效,并探讨影响术后局部复发及肢体功能[国际骨与软组织肿瘤协会功能评分(MSTS)]的相关因素。结果:患者均顺利完成手术,手术成功率100%。患者随访25~76个月,平均随访52.8个月,无转移及死亡病例;末次随访时,MSTS评分为(26.25±2.51)分,其中优42例,良28例,可4例,差1例,优良率93.33%。单因素分析显示,股骨近端骨肿瘤人工髋关节置换术后局部复发与性别、年龄、肿瘤大小、病理性骨折、Campanacci分级、截骨长度及是否保留股骨大转子均无关(P>0.05);而无病理性骨折、Campanacci分级为II级、截骨长度≤12 cm、保留股骨大转子者术后MSTS评分均分别明显优于有病理性骨折、Campanacci分级为III级、截骨长度>12 cm及未保留股骨大转子者(P<0.05)。结论:人工全髋关节置换术是治疗股骨近端骨肿瘤安全、有效,是否伴病理性骨折、Campanacci分级、截骨长度、是否保留股骨大转子是影响患者术后肢体功能恢复的因素。

Objective:To investigate the curative effect of artificial hip replacement in the treatment of proximal femoral bone tumors and influencing factors of the prognosis.Methods:Seventy-five patients with proximal femoral bone tumors who underwent artificial hip replacement were enrolled in the study.The curative effect was evaluate and related factors influencing postoperative local recurrence and limb function[Musculoskeletal Tumor Society(MSTS)] were investigated.Results:All patients underwent surgery successfully,with a success rate of 100%.The patients were followed up for 25 to 76 months,with an average of 52.8 months.There was no metastasis or death.The MSTS score was(26.25±2.51) points at the last follow-up.The scores of 42 cases were excellent,of 28 cases were good,of 4 cases were not bad and of 1 case was poor.The excellent and good rate was 93.33%.Univariate analysis showed that local recurrence after artificial hip replacement of proximal femoral bone tumors was not related to gender,age,tumor size,pathological fracture,Campanacci classification,length of osteotomy or whether the greater trochanter of femur was preserved(P>0.05).MSTS scores of patients with pathological fractures,Campanacci grade II,the length of osteotomy of or shorter than 12 cm and preservation of greater trochanter of femur were significantly better than those without pathological fractures,with Campanacci grade III,length of osteotomy longer 12 cm and without preservation of greater trochanter of femur(P<0.05).Conclusion:Artificial hip replacement is a safe and effective method for the treatment of proximal femoral bone tumors.Pathological fracture,Campanacci classificatio,length of osteotomy and preservation of greater trochanter of femur are factors affecting the recovery of postoperative limb function.