定制型节段假体重建长骨骨干转移瘤骨缺损

Customized segmental prosthetic reconstruction for bone defect of long bone diaphyseal metastatic tumors

目的探讨定制型节段假体重建治疗长骨骨干转移瘤骨缺损的临床效果。方法应用定制型节段假体重建治疗15例长骨骨干转移瘤骨缺损患者。采用Kaplan-Meier法计算患者生存率,NRS评分评估术后疼痛,MSTS 93评分系统评估术后肢体功能。结果8例存活,随访时间16~56(29.75±13.20)个月;7例死亡,随访时间12~44(23.86±12.24)个月。术后1年患者总生存率93.3%,术后2年患者总生存率73.3%。假体在体时间12~56(27.00±13.10)个月,假体长度6~13(9.73±2.15)cm。术后3个月MSTS评分24~29(26.87±1.55)分。NRS评分术前4~8(6.20±1.15)分,术后1个月0~1(0.20±0.40)分,差异有统计学意义(P<0.05)。1例肱骨转移瘤患者术后6个月复查出现影像学无菌性松动,未明显影响上肢功能。结论定制型节段假体重建长骨骨干转移瘤骨缺损具有缓解疼痛明显、允许早期负重及功能锻炼、保留较好肢体功能、术后并发症发生率较低等优势。

Objective To evaluate the clinical effect of customized segmental prosthetic reconstruction for bone defect of long bone diaphseal metastatic tumors.Methods Fifteen patients with bone defect of long bone diaphseal metastatic tumors were treated with customized segmental prosthetic,Kaplan-Meier method was used to calculate the survival rate of patients,the NRS score was used to evaluate postoperative pain,and the MSTS 93 score was used to evaluate postoperative limb function.Results Eight patients survived,the follow-up time was 16~56(29.75±13.20)months.Seven patients died,the follow-up time was 12~44(23.86±12.24)months.The postoperative 1-year survival rate was 93.3%,the postoperative 2-year survival rate was 73.3%.Duration of prosthesis survival was 12~56(27.00±13.10)months,length of the prosthesis length was 6~13(9.73±2.15)cm.MSTS score was 24~29(26.87±1.55)points at 3 months after surgery.NRS score was 4~8(6.20±1.15)points before surgery,and 0~1(0.20±0.40)points at 1 month after surgery,with statistically significant differences(P<0.05).Imaging aseptic loosening occurred in 1 patient with humerus metastatic tumor at 6 months after surgery,the upper limb function was not significantly effected.Conclusions Customized segmental prosthetic reconstruction for bone defect of long bone diaphyseal metastatic tumors has the advantages of significantly reducing pain,allowing early weight bearing and early functional exercise,with better limb function,and lower incidence rate of postoperative complications.