摘要
目的探讨引起股骨远端骨肿瘤假体置换术后非肿瘤复发性失败的原因及其处理方法。方法回顾2006年1月至2013年12月于我院治疗的78例股骨远端骨肿瘤患者。其中58例骨肉瘤、16例骨巨细胞瘤及4例其它骨与软组织肿瘤。初次手术为保肢手术,所用假体为组配水泥型假体。对出现的感染、假体障碍及无菌性松动等非肿瘤复发因素并发症进行二次手术并随访。结果 78例患者出现了6例无菌性松动、3例深部感染、3例软组织愈合不良和1例假体部件脱位。13例为男9例,女4例,出现并发症的平均年龄为25.6(16~37)岁。至随访终点,共计有10例假体失败,总体假体的5年预期生存率为81.4%。对无菌性假体松动病例分析发现,患者初次假体置换术后2个月恢复功能活动的体重指数(BMI)及患者切除肿瘤后骨缺损占比(尤其>40%)是引起假体无菌性松动的独立因素。同时6例无菌性松动患者的平均年龄为27.1岁,进行危险因子分析发现年龄<40岁的运动能力较强的患者倾向于出现无菌性松动(P=0.197)。3例深部感染的患者出现在术后1个月之内并进行了多次手术,最终2例采取一期取出假体二期翻修的治疗方法,余下1例截肢。1例假体部件脱位发生在术后第2个月,立即进行了切开复位。6例无菌性松动发生的时距初次手术时间跨度平均为45(28~75)个月,翻修前MSTS评分平均为14.3(12~17)分,翻修采用延长假体柄的定制水泥型假体,假体柄延长长度平均为5.2(4~6)cm,翻修术后随访平均时间为34.3(18~58)个月,无一例出现再次无菌性松动及其它假体相关性并发症,翻修后6例假体到目前随访终止的MSTS评分28.5(27~30)分。结论无菌性松动是股骨远端骨肿瘤假体非肿瘤性再次手术的主要原因。无菌性松动的假体翻修时选择延长假体柄的定制水泥型假体能够达到良好的治疗效果。
Objective To investigate the non-recurrent factors and management of the failed tumor prosthesis reconstructed for the bone defect in the distal femur. Methods A retrospective analysis was performed on 78 patients with bone tumors in the distal femur from January 2006 to December 2013, and the diagnoses were pathologically confirmed, including 58 patients with osteosarcoma, 16 with giant cell sarcoma and 4 others. Limb salvage procedure with custom cemented prosthesis was chosen as the primary surgery strategy. We analyzed the factors of failure during the follow-up, reoperation was performed on the patients with failed prostheses after complications of deep infection, aseptic loosening and mechanical obstruction. Results Until the end of follow-up, 13 complications occurred, including 6 patients with aseptic loosening, 3 with deep infection, 3 with poor wound healing and 1 with dislocated component of prosthesis. There were 9 males and 4 females, whose average age was 25.6 years （ range： 16 - 37 years ） when complications occurred. There were 10 failed prostheses until the end of follow-up, and the expected 5-year survival rate was 81.4%. Through analyzing the risky factors that might result in aseptic loosening, we found that higher body mass index （ BMI ） in the patients whose joint function got recovered at 2 months after primary prosthesis replacement and lager bone defect after tumor resection especially when bone defect 〉 40% were independent risky factors of aseptic loosening which could result in prosthesis failure. The mean age of the 6 patients with aseptic loosening was 27.1 years. More athletic younger patients （ 〈 40 years ） were prone to incur the incidence of aseptic loosening （ P = 0.197 ）. Deep infection happened to 3 patients within the first month after primary surgery, of whom,2 patients received second-stage revision after removing the prosthesis and 1 patient accepted amputation. The patient with dislocated component at the second month after surgery received open reduction immediately. Six patients with aseptic loosening underwent revision with new custom cemented prosthesis with additional stem length （ average： 5.2 cm, range： 4 - 6 cm ） and wider diameter. The average follow-up from the primary operation to the incidence of complications was 45 months （ range： 28 - 75 months ）. The average MSTS score raised from 14.3 （ range： 12 - 17 ） before revision to 28.5 （ range： 27 - 30 ） after an average follow-up of 34.3 months （ range： 18 - 58 months ）. No incidence of complications was recorded after reoperation. Conclusions Aseptic loosening is the major non-recurrent factor of the failed tumor prosthesis in the distal femur and satisfactory outcomes can be gained after revision with new custom cemented prosthesis with longer stem length and wider diameter.
出处
《中国骨与关节杂志》
CAS
2017年第6期415-420,共6页
Chinese Journal of Bone and Joint
关键词
股骨
骨肿瘤
假体植入
手术后并发症
Femur
Bone neoplasms
Prosthesis implantation
Postoperative complications
