Zang Jie, Guo Wei, Yang Yi, Ji Tao, Zhang Yidan
Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing, 100044, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2013 Jan;27(1):41-4.
To evaluate the effectiveness of bipolar prosthetic replacement for proximal femoral tumors from the perspectives of patient survival, prosthesis survival, functional outcomes, and complication rates.
Between July 2001 and July 2010, 96 patients with proximal femoral tumors underwent wide resection and bipolar prosthetic replacement, including 83 cases of primary femoral tumors and 13 cases of soft tissue sarcomas involving the proximal femur. There were 50 male and 46 female patients with a mean age of 43.2 years (range, 15-69 years). Prosthetic replacement for proximal femoral tumors was used in 85 patients and deactivated bone-prosthetic complex was used in 11 patients. According to Enneking staging, the patients were divided into 3 groups: group A, 24 patients at stages IA, IB, and benign lesion; group B, 56 patients at stages IIA and IIB; and group C, 16 patients at stage III, myeloma, and lymphoma. The American Musculoskeletal Tumor Society 1993 version (MSTS93) functional score was used to evaluate the lower limb function.
Primary healing of incision was obtained in 93 patients; 3 patients had poor healing, which was cured after debridement. Of the patients, 89 were followed up 6.5 years on average (range, 1-10 years). During follow-up, 28 patients died of tumor. The 5- and 10-year survival rates of patients were 100% in group A, and were 56.5% and 41.5% in group B respectively, and the 5-year survival rate was 18.4% in group C; there was significant difference among 3 groups (P < 0.01). The 5- and 10-year survival rates of prosthesis were 74.4% and 62.5%, which were significantly higher than those of patients in groups B and C (P < 0.01). Sixty-one patients were followed up 1-10 years (mean, 4.7 years) for functional evaluation. The mean MSTS93 score of the survival patients was 79% (range, 63%-95%) at last follow-up. Complications were observed in 15 patients (16.9%): hip dislocation in 2, delayed infection in 2, aseptic loosening in 8, severe acetabulum wear in 1, and hip pain in 2.
Bipolar proximal femoral prosthetic replacement for proximal femoral tumors can provide a satisfactory functional outcome, especially for tumors at stage II or III and myeloma and lymphorma patients. Revision is needed because of main late complications of aseptic loosening, hip pain, and acetabulum wear.
从患者生存率、假体生存率、功能结果和并发症发生率的角度评估双极假体置换治疗股骨近端肿瘤的有效性。
2001年7月至2010年7月，96例股骨近端肿瘤患者接受了广泛切除和双极假体置换，其中原发性股骨肿瘤83例，累及股骨近端的软组织肉瘤13例。男性50例，女性46例，平均年龄43.2岁（范围15 - 69岁）。85例患者采用股骨近端肿瘤假体置换，11例患者采用灭活骨 - 假体复合物。根据Enneking分期将患者分为3组：A组24例，处于IA期、IB期和良性病变；B组56例，处于IIA期和IIB期；C组16例，处于III期、骨髓瘤和淋巴瘤期。采用美国肌肉骨骼肿瘤学会1993版（MSTS93）功能评分评估下肢功能。
93例患者切口一期愈合；3例愈合不佳，清创后治愈。89例患者获得随访，平均随访6.5年（范围1 - 10年）。随访期间28例患者死于肿瘤。A组患者5年和10年生存率均为100%，B组分别为56.5%和41.5%，C组5年生存率为18.4%；3组间差异有统计学意义（P < 0.01）。假体5年和10年生存率分别为74.4%和62.5%，显著高于B组和C组患者（P < 0.01）。61例患者接受1 - 10年（平均4.7年）功能评估。末次随访时生存患者MSTS�3评分平均为79%（范围63% - 95%）。15例患者（16.9%）出现并发症：髋关节脱位2例，延迟感染2例，无菌性松动8例, 严重髋臼磨损1例，髋关节疼痛2例。
双极股骨近端假体置换治疗股骨近端肿瘤可提供满意功能结果，尤其对于II期或III期肿瘤以及骨髓瘤和淋巴瘤患者。因无菌性松动、髋关节疼痛和髋臼磨损等主要晚期并发症需要翻修。
