摘要
目的总结分析定制型膝肿瘤假体的设计与临床应用经验。方法回顾性分析1999年6月～2002年10月膝关节周围骨肿瘤41例。男29例,女12例;年龄11～69岁,平均35.0岁。股骨远段肿瘤32例,胫骨近段肿瘤9例。骨肉瘤15例,骨巨细胞瘤13例,软骨肉瘤3例,孤立性骨转移瘤5例,纤维肉瘤、恶性纤维组织细胞瘤、尤文氏瘤、小圆细胞肉瘤及韧带样纤维瘤各1例。于包膜外截除肿瘤段后置入定制的半制约式带股骨(或胫骨)膝关节假体,其中1例11岁患儿置入假体的股骨段有后期延长装置。1例患者术中行股动脉切除、大隐静脉移植修补术。结果41例手术均顺利完成。随访时间超过8个月的33例平均随访20.2个月。所有患者均于术后3个月内恢复日常生活能力。术后肿瘤有2例局部复发,有3例远处转移。膝关节假体的设计保证膝关节在伸屈活动的同时,可适度的内外旋与内外翻,并保持关节稳定性;还为胫骨近段截除患者提供了效果较好的重建髌韧带止点的假体设计与手术方法,术后患者伸膝功能恢复满意。无假体松动、断裂等并发症。结论定制型膝关节肿瘤假体为半制约式,只需定做有特殊需要的部件,其他部件选用预制的标准部件,这样有利于缩短定制周期、保证质量和降低费用,可作为股骨远段或胫骨近段肿瘤患者保肢治疗的方法之一。
Objective To analyze the practical experiences of design and its clinical application of custom-made tumor prostheses of knee. Methods A retrospective study of 41 cases of distal femur or proximal tibia tumors treated surgically from June 1999 to October 2002, was carried out. In the study, there were 29 males and 12 females aging from 11 to 69 years with an average of 35.0 years. The location of tumors were at distal femur in 23 cases and 9 cases at proximal tibia, of which 15 were osteosarcoma, 13 giant cell tumor, 3 chondrosarcoma, 5 solitary metastatic bone tumor, and 1 each of fibrosarcoma, malignant fibrohistocytoma, Ewings sarcoma, small round cell sarcoma and syndesmofibroma. The custom-made semi-constrained knee prosthesis with femoral or tibial component was implanted after extra-capsular resection of the tumor bone segment. A special femoral component with elongated construction was used in an 11-year old case for further femur lengthening. Resection of femoral artery involved by tumor and reparation by great saphenous vein was performed in one case. Results The operations of the 41 cases were all smoothly performed. 33 cases were followed up from 8 to 37 months with an average of 20.2 months. The daily life ability was recovered in 3 months after the operation. Among them, no loosening or failure of the prostheses was found, and local recurrence was found in 2 cases and distant metastasis in 3 cases. The design of knee prosthesis could provide some proper internal/external rotation and adduction/abduction movements accompanying with the flexion and extension of the knee joint without affecting the stability of the joint. For the case of proximal tibia tumor, a special design and surgical technique was developed to provide the reconstruction of patellar ligament insertion with rather good results; and the recovery of knee extension and stability were satisfied. Conclusion The custom-made semi-constrained tumor prosthesis of knee could be used as an effective method for the limb-savage management either the distal femur or proximal tibia tumor cases.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2003年第10期606-610,共5页
Chinese Journal of Orthopaedics
