Wang Z, Ma Z S, Huang Y T
Department of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an Shanxi, P. R. China 710032.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2001 Jan;15(1):5-8.
To analyze the indications for revision surgery after limb salvage procedure of malignant bone tumor and summarize the experiences in revision surgery.
From January 1994 to December 1997, 8 cases were re-operated after primary limb salvage procedure. The average survival period with no-tumor occurrence was 8 years. The common causes for the revision were traumatic osteoarthritis, fracture, and bone resorption. The main difficulties in revision were soft tissue contracture and limb discrepancy from limb shortening.
In this study, there was total hip replacement in 1 case, large segmental allograft for reconstruction of distal femur in 3 cases, total knee replacement upon composite of previously transplanted allograft in 3 cases, removing of intramedullary nail and re-internally fixed with intramedullary nail in 1 cases. The isotopic bone scan before the revision showed active bone metabolism in all 4 transplanted segmental allograft. The pathologic study of the transplanted allograft after revision confirmed new bone formation in allograft. The revision procedure reduced the pain, and improved the limb function.
The main causes of revision surgery after limb salvage procedure of malignant bone tumor are fracture of transplanted allograft segment or devitalized tumor segment, and poor function of the affected joint. Constrained knee prostheses with rotating hinges or semi-constrained ball-axis resurfacing knee prostheses improve the function of knee joint postoperatively.
分析恶性骨肿瘤保肢手术后翻修手术的适应证并总结翻修手术经验。
1994年1月至1997年12月，对8例保肢手术后患者进行再次手术。无瘤生存平均时间为8年。翻修的常见原因是创伤性骨关节炎、骨折和骨吸收。翻修的主要困难是软组织挛缩和肢体短缩导致的肢体不等长。
本研究中，1例行全髋关节置换术，3例行大段同种异体骨移植重建股骨远端，3例行全膝关节置换术（此前移植的同种异体骨复合后），1例行取出髓内钉并重新髓内钉内固定。翻修术前同位素骨扫描显示所有4段移植的同种异体骨均有活跃的骨代谢。翻修后移植同种异体骨的病理研究证实同种异体骨中有新骨形成。翻修手术减轻了疼痛，改善了肢体功能。
恶性骨肿瘤保肢手术后翻修手术的主要原因是移植的同种异体骨段或失活肿瘤段骨折以及患关节功能不佳。带旋转铰链的限制性膝关节假体或半限制性球轴表面置换膝关节假体可改善术后膝关节功能。
