摘要
目的应用大段异体骨移植及踝关节融合的保肢方法治疗胫骨下端恶性肿瘤和侵袭性肿瘤，并从预后、术后并发症及功能等几个方面加以评价。方法自1998年1月至2005年12月应用大段异体骨移植及踝关节融合的保肢方法治疗胫骨下端肿瘤患者11例；包括骨肉瘤8例，骨巨细胞瘤2例，软骨肉瘤1例。对骨肉瘤患者行新辅助化疗，按照Enneking分期，手术行边缘切除或广泛切除，应用大段深低温冷冻保存同种异体骨重建，钢板螺钉或带锁髓内钉固定。结果术后随访18-78个月，平均47个月。其中8例骨肉瘤患者随访28-78个月，平均50个月。11例均获得良好的骨愈合，开始出现骨愈合时间为术后3-18个月，平均8个月。无异体骨反应继发感染，无内固定失败。异体骨骨折1例，复发2例，肺转移3例，保肢率为81．8％。术后功能评定采用骨骼肌肉系统肿瘤手术治疗后重建功能评估系统（MSTS系统），评分为16～27分，平均24-3分。结论胫骨下端虽然软组织覆盖较薄，血运相对较差，但保肢术后肿瘤复发率不高，异体骨感染、不愈合、骨折率较低。固定方式以髓内固定为佳。大段异体骨移植及踝关节融合的保肢方法术后功能良好，给患者带来较大的心理安慰，是一种较好的保肢方式。
Objective Allograft ankle arthrodesis is a new limb salvage procedure for the treatment of malignant or aggressive tumors of distal tibia. The protocol is retrospectively evaluated in its prognosis, complications and functions. Methods Between January 1998 and December 2005, 11 patients were ineluded in this study. There were 8 osteosarcomas, 1 chondrosarcoma, and 2 giant cell tumors of bone. Eight patients with osteosareoma were treated with neo-adjuvant chemotherapies before operation. The surgical margins are wide or marginal according to the tumor staging of Enneking system. After tumor resection, the primary ankle arthrodesis was accomplished using deep frozen preserved allograft and retrograde intramedullary nail or dynamic compression plate. Results The mean follow-up was 47 months （range, 18 to 78 months）. Eight patients with osteosarcoma were followed up average 50 months （range, 28 to 78 months）. The time to bone union was 8 months （range, 3 to 18 months）. There were no infection, immunologic complication and nonunion. One had allograft fracture. Two of 8 patients with osteosarcoma had local recurrences. Three patients with osteosareoma had pulmonary metastases. The limb-salvage rate was 81.8%. Function as- sessment was performed using Musculoskeletal Tumor Society （MSTS） score, the average score of the patients is 24.3. Conclusion Although the soft tissue coverage and blood circulation of distal tibia are poor, the local recurrence rate is low following tumor resection. The procedure of resection-arthrodesis of the ankle using a large allograft with an intramedullary nail or dynamic compression plate provides patients with a satisfactory reconstruction, and the procedure carries a low incidence of infection, non-union, fracture. Intramedullary fixation was recommended in this protocol.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2008年第2期112-116,共5页
Chinese Journal of Orthopaedics
关键词
移植
同种
骨肿瘤
踝关节
关节融合术
Transplantation, homologous
Bone neoplasms
Ankle joint
Arthrodesis
