四肢与骨盆骨肿瘤定制型假体置换术中软组织修复与重建的评价与策略

Evaluation and strategy of soft tissue repair and reconstruction in extremity and pelvic tumor customized prosthetic replacement

目的研究四肢与骨盆骨肿瘤切除后定制人工骨关节置换术中软组织重建的方法和意义。方法自2011-05—2017-10收治四肢与骨盆骨肿瘤46例(47侧),其中20例(21侧)选择定制人工骨关节置换保肢术,肿瘤采取广泛切除或根治性切除后使用定制型假体置换保肢,术中进行个性化的软组织修复与重建,记录各型患者的手术重建方式及术后随访情况。结果术后随访(26.0±21.1)个月。所有原发性骨肿瘤患者均存活,骨盆骨肉瘤1例于术后9个月复发,4例转移瘤患者出现复发或再转移,最终死亡。2例左全髋+股骨近中段置换患者分别于术后1周和5周出现髋关节脱位经手法复位成功,其余患者术后均未出现人工关节脱位、假体松动和断裂。术后MSTS93评分优良率达95.2%。结论四肢与骨盆骨肿瘤切除后,选择合适假体修复骨缺损的同时,对相关软组织进行个性化的解剖修复与功能重建,将有利于获得术后患肢良好功能以及置入假体的长期使用。

Objective To explore the method and significance of soft tissue reconstruction in customized artificial joint replacement after the resection of extremities and pelvis tumours.Methods From May 2011 to October 2017,47 sides of 46 patient with bone tamors of extremites and pelvis were treated,of which 20 cases(21 sides)underwent customized artificial joint replacement for limb salvage.After extensive resection or radical resection,customized prosthesis was used to replace the limb,and individualized soft tissue repair and reconstruction were carried out during the operation.The reconstruction methods and postoperative follow-up of all types of patients were recorded.Results Postoperative follow-up averaged(26.0±21.1)months.All patients with primary bone tumors survived.Pelvic osteosarcoma recurred in one case 9 months after surgery.Four patients with metastatic tumor had recurrence or re-metastasis and died.Two cases who underwent total hip arthroplasty plus proximal and middle femoral replacement were successfully repositioned by manipulation after dislocation of prosthesis hip occurred one week and 5 weeks after operation.No dislocation,prosthesis loosening or fracture occurred in the other cases.The excellent rate of postoperative MSTS93 was 95.2%.Conclusion After resection of bone tumors of extremities and pelvis,it will be helpful to obtain good function of the affected limbs and long-term use of implants to select suitable prostheses to repair bone defects and individualized anatomical repair and functional reconstruction of related soft tissues.