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生物型APC重建股骨近端瘤性骨缺损的保肢技术及疗效分析

Therapeutic Effect of Uncemented Allograft-prosthetic Composite for the Reconstruction of Tumorous Bone Defect

  • 摘要: 目的 探讨生物型同种异体骨-假体复合物(allograft-prosthetic composite,APC)重建股骨近端肿瘤切除后骨缺损的手术方法和中期疗效。 方法 收集2007~2011年在我科接受股骨近端肿瘤切除、生物型APC重建的15例患者资料及病理结果;术后第1、3、6、9、12月及之后每半年对患者进行影像学检查及功能随访评估。影像学评估主要包括骨-骨界面愈合情况及大转子骨吸收情况;采用骨与软组织肿瘤协会评分(MSTS)及Harris髋关节评分(HHS)评估患者关节功能,采用查体评估患者外展肌肌力。结果 本组15例患者中,男7例,女8例,平均年龄25.1岁(17~56岁);平均随访时间32.8月(18~48月);病理学诊断:骨巨细胞瘤4例,骨肉瘤3例,软骨肉瘤3例,恶性纤维组织细胞肿瘤2例,骨母细胞瘤2例,尤文氏肉瘤1例。15例患者异体骨-宿主骨界面均获骨性愈合,愈合时间为5~9月;至末次随访时,未出现感染、异体骨-宿主骨愈合处骨吸收、髋关节脱位、异体骨超敏反应、髋臼磨损及肿瘤复发和转移等并发症。3例患者术中出现假体周围骨折,以钢丝环扎术固定。术后6例患者出现大转子骨吸收。15例患者平均MSTS评分和HHS评分,术前为11.3分(7~15分)和47.3分(40.3~58.5分),末次随访时为26.1分(24~29分)和80.1分(66.2~92.7分)。结论 生物型APC应适用于年龄轻、预期生存时间长及术后功能要求高的股骨近端骨肿瘤患者。

     

    Abstract: Objective To investigate the surgical techniques and mid-term efficacy of reconstruction for proximal femur with allograft-prosthetic composite (APC). Methods Fifteen patients who underwent uncemented APC reconstruction of proximal femur after bone tumor resection were retrospectively evaluated. Image and physical examinations were taken on the 1st, 3rd, 6th, 9th and 12th month after surgery and every 6 months thereafter to assess union condition, greater trochanteric bone absorption and myodynamia of abductors. Musculoskeletal Tumor Society (MSTS) and Harris Hip Score (HHS) were utilized to evaluate the function of hip joint. Results Seven male and eight female patients were included with average age of 25.1 years(17-56 years) and average followup of 32.8 months(18-48 months). Four patients had giant cell tumor of the bone, 3 patients had osteosarcoma, 3 patients had chondrosarcoma, 2 patients had malignant fibrous histiotoma, 2 patients had osteoblastoma and 1 patient had Ewing sarcoma. Unions occurred in the allograft-host bone interfaces of all patients in the period of 5-9 months postoperatively. Bone absorption in the allograft-host bone interfaces, dislocation, hypersensitivity of the allograft and acetabulum abrasion were not observed, while there were no metastasis and tumor recurrence. Three patients had periprosthetic fractures intraoperatively and were well fixed with cerclage. Absorptions in the greater trochanteric happened to 6 patients. All patients had mean MSTS and HHS scores of 11.3 (7-15) and 47.3 (40.3-58.5) preoperatively and 26.1(24-29) and 80.1(66.2-92.7) postoperatively. Conclusion Uncemented APC reconstruction is proper for young patients with long life expectancy and high demand of function that suffered from tumors of proximal femur.

     

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