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[股骨近端肿瘤切除术后的人工关节重建]

[Endoprosthetic reconstruction after resection of the tumor of the proximal femur].

作者信息

Guo Wei, Yang Yi, Tang Xiao-dong, Ji Tao

机构信息

Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing 100044, China.

出版信息

Zhonghua Wai Ke Za Zhi. 2007 May 15;45(10):657-60.

Abstract

OBJECTIVE

To evaluate the outcome and complications of endoprosthetic reconstruction after wide tumor excision on the patients with neoplasms at the proximal femur.

METHODS

Between July 1998 and July 2005, 81 patients with tumor of the proximal femur were treated by wide excision and endoprosthetic reconstruction. Nine cases received devitalized bone and prosthesis composite reconstruction (among them, 3 patients of fibrous dysplasia had long stem bipolar hip replacement) and 5 cases had allograft prosthesis composite replacement. Two cycles of neoadjuvant chemotherapy were given to all the cases of osteosarcoma and Ewing sarcoma. The functional outcomes were evaluated by MSTS 93 score.

RESULTS

Among the 30 patients with metastatic tumor, because all of them were transferred to related department to receive chemotherapy or radiotherapy after surgery, the follow-up was not doing well and the rate of local recurrence was not confirmed. Five patients with metastatic tumors died in 3 months after surgery. Most patients had excellent or good function postoperatively, the average MSTS 93 score was 25 in 6 months after surgery. Among the 51 patients with primary tumor, 2 patients had chronic infection and 2 patients had loosening of the prosthesis during the following time. Allograft bone and host bone nonunion were seen in 2 cases. Two patients with bipolar hip replacement had severe acetabulum abrasion. The other 3 patients also received total hip replacement for hip pain after walk. Five patients had local recurrence 6 months to 2 years postoperatively.

CONCLUSIONS

Because of low complication rate and good postoperative function, endoprosthetic replacement is a good option for reconstruction of the proximal femur after tumor resection.

摘要

目的

评估股骨近端肿瘤患者行广泛肿瘤切除术后人工关节置换重建的疗效及并发症。

方法

1998年7月至2005年7月,81例股骨近端肿瘤患者接受了广泛切除及人工关节置换重建。9例采用灭活骨与假体复合重建(其中3例纤维结构不良患者行长柄双极髋关节置换),5例采用同种异体骨假体复合置换。所有骨肉瘤和尤文肉瘤患者均接受了两个周期的新辅助化疗。采用MSTS 93评分评估功能结局。

结果

30例转移性肿瘤患者中,因术后均转至相关科室接受化疗或放疗,随访不佳,未证实局部复发率。5例转移性肿瘤患者术后3个月内死亡。多数患者术后功能优良,术后6个月平均MSTS 93评分为25分。51例原发性肿瘤患者中,随访期间2例发生慢性感染,2例假体松动。2例出现异体骨与宿主骨不愈合。2例行双极髋关节置换的患者髋臼磨损严重。另外3例患者也因行走后髋关节疼痛接受了全髋关节置换。5例患者术后6个月至2年出现局部复发。

结论

人工关节置换重建并发症发生率低,术后功能良好,是股骨近端肿瘤切除术后重建的良好选择。

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