Guzik Grzegorz
Department of Oncological Orthopaedics, Specialist Hospital in Brzozów - Podkarpacie Oncological Centre.
Ortop Traumatol Rehabil. 2017 Apr 12;19(2):157-164. doi: 10.5604/15093492.1238003.
Disarticulation has been used less and less often in the treatment of musculoskeletal neoplasms; however, in some cases it allows the patient to achieve good oncological and functional outcomes. The aim of this paper is to present the possibilities, surgical technique and treatment outcomes of patients after hip disarticulation and stump lengthening with a modular prosthesis.
Three classic hip disarticulation surgeries and 2 hip disarticulation procedures with stump lengthening with a modular prosthesis were performed at the Department of Oncological Orthopaedics in Brzozów in 2013 and 2014. The present paper discusses the indications, surgical technique and outcomes. Pain intensity was assessed in a VAS scale and physical function was measured with the Karnofsky scale. The mental status of the patients was analysed in the Beck Depression Inventory and the ability to perform daily living activities was evaluated according to Katz. The ability to walk after surgery was assessed.
Patients after hip disarticulation showed considerably worse functional outcomes. The mean physical function score was 53 points in the Karnofsky scale and 3.33 points in the Katz scale. The patients had difficulty walking and did not ambulate with their prostheses. They reported problems with sitting and using the toilet. Patients with lengthened stumps showed visibly better physical function scores, achieving, on average, 65 points in the Karnofsky scale and 5.5 points in the Katz scale. These patients used their prostheses, ambulated efficiently and were independent.
Stump lengthening with a modular prosthesis in patients after hip disarticulation results in significantly better outcomes than the classic procedure.
关节离断术在肌肉骨骼肿瘤治疗中的应用越来越少；然而，在某些情况下，它能使患者获得良好的肿瘤学和功能预后。本文旨在介绍髋关节离断术及使用模块化假体延长残端后的可能性、手术技术及治疗效果。
2013年和2014年，在布罗佐夫肿瘤骨科进行了3例经典髋关节离断术和2例使用模块化假体延长残端的髋关节离断术。本文讨论了手术适应症、技术及结果。采用视觉模拟评分法（VAS）评估疼痛强度，用卡氏评分法测量身体功能。根据贝克抑郁量表分析患者的心理状态，并按照卡茨量表评估日常生活活动能力。评估术后行走能力。
髋关节离断术后患者的功能预后明显较差。卡氏评分法中平均身体功能评分为53分，卡茨量表评分为3.33分。患者行走困难，不能使用假肢行走。他们报告了坐立和使用厕所方面的问题。残端延长的患者身体功能评分明显更好，卡氏评分法平均达到65分，卡茨量表评分为5.5分。这些患者使用假肢，行走效率高且独立。
髋关节离断术后患者使用模块化假体延长残端的效果明显优于经典手术。
