骨干骨肉瘤保肢手术的不同重建方式对比

Comparison of different reconstruction methods in limb salvage surgery for diaphysial osteosarcoma

目的比较骨干骨肉瘤保肢手术生物重建与假体重建的肢体功能和患者满意度。方法回顾性分析2015年1月至2020年10月,我院收治的26例骨干骨肉瘤患者。年龄4~53岁,平均(18.35±12.81)岁。性别差异无统计学意义。肿瘤均位于四肢长干骨,根据Ennking肿瘤分期[1],ⅡA期14例,ⅡB期8例,Ⅲ期4例。根据重建方法分为生物重建组(18例)和定制假体重建(8例)。生物重建组18例中自体腓骨重建13例,大段异体骨重建5例。结果随访3~70个月,平均(31.15±14.13)个月。ISOLS总分:定制假体组(24.00±2.69)分优于生物重建组(17.11±1.70)分,P=0.037;各单项比较中,仅患者心理满意度方面定制假体组(3.63±0.42)优于生物重建组(2.28±0.32),P<0.05,而其它单项两者比较差异无统计学意义。生物重建组出现骨折、不愈合、感染及局部复发并发症8例次,定制假体组出现松动、感染及局部复发并发症3例次,两者差异无统计学意义。结论骨干骨肉瘤保肢治疗选择不同重建方式对预后无明显影响,但定制假体重建功能优于生物重建,可较快恢复行走及持物功能。

Objective To compare the limb function and patient satisfaction of the limb salvage surgery for diaphysial osteosarcoma with biological reconstruction or prosthetic reconstruction.Methods A total of 26 cases with diaphysial osteosarcoma were treated in our hospital from January 2015 to October 2020.Clinical data were retrospectively analyzed.The average age was(18.35±12.81)years(range:4-53 years).There were no significant differences in the gender.The tumors all located in the long bones of the limbs.There were 14 cases of stageⅡA,8 cases of stageⅡB and 4 cases of stageⅢaccording to Ennking tumor staging.All patients were divided into biological reconstruction group(n=18)and custom-made prosthesis group(n=8).Biological reconstruction included autologous fibula reconstruction in 13 cases and massive allograft bone reconstruction in 5 cases.Results The average follow-up was(31.15±14.13)months(range:3-70 months).The total SOLS score of the customized-prosthesis group(24.00±2.69)was superior than that of the biological reconstruction group(17.11±1.70)(P=0.037).Psychological satisfaction of the customized-prosthesis group(3.63±0.42)was better than that of the biological reconstruction group(2.28±0.32)(P<0.05).No significant differences were observed in other comparisons.Complications were noted in 8 patients of the biological reconstruction group,including fracture,nonunion,infection and local recurrence;complications were noted in 3 patients of the custom-made prosthesis group,including loosening,infection and local recurrence;the differences between the two were not statistically significant.Conclusions The choice of different reconstruction methods will not affect the prognosis.However,the limb functions of the custom-made prosthesis group are better than that of the biological reconstruction group,which will facilitate quicker recovery of walking and holding.