摘要
回顾性分析2003-03/2008-03重庆医科大学附属第一医院骨科收治的股骨近端转移性骨肿瘤患者13例,男8例,女5例,年龄28～65岁。原发肿瘤:乳腺癌4例,肺癌3例,前列腺癌2例,肾癌1例,甲状腺癌1例,不明来源2例。置换前已发生病理性骨折者3例。全部病例均经病理证实为转移性骨肿瘤,并采用病灶刮除+人工髋置换治疗,假体类型:人工全髋关节假体9例,人工双极股骨头4例。置换后3个月随访,进行围置换期安全性及并发症、影像学、疼痛缓解、肢体功能Enneking评分及生活质量Kanofsky评估。所有患者均安全度过围置换期,无深部感染及深静脉血栓形成。置换后3个月存活12例,1例肾癌患者于置换后2个月由于肿瘤转移扩散致全身衰竭死亡。骨盆平片上出现髋臼侧透亮线2例,无骨溶解、松动、脱位及股骨柄下沉;疼痛评估完全消失2例,明显缓解6例,部分缓解3例,无效1例,总缓解率91.7%;Enneking评分优3例,良5例,中3例,差1例,优良率为66.7%;Kanofsky评分显效6例,有效3例,总有效率75%。提示人工关节重建治疗股骨近端转移性肿瘤短期内可有效缓解疼痛,改善关节功能,提高生活质量。
A total of 13 cases with metastatic tumor of bone involving the proximal femur, including 8 male and 5 female with an average age of 46 years （range 28-65 years） were selected from Department of Orthopaedics, the First affiliated Hospital of Chongqing Medical University from March 2003 to March 2008. Diagnoses included metastatic breast carcinoma in 4 patients, lung carcinoma in 3, prostate carcinoma in 2, renal carcinoma in 1, thyroid carcinoma in 1, and poorly differentiated carcinoma in 2. Three of 13 patients had complete pathologic fracture before the operation. All patients were treated with curettage of lesion and artificial prosthesis replacement, including 9 patients received artificial total hip replacement and 4 underwent bipolar artificial femoral head replacement. The patients were followed up since the third month postoperatively and evaluated clinically and radiographically respectively for pain relief, limb function by Enneking score and quality of life by Kanofsky. All patients were in good condition during the operation with no deep infection or deep venous thrombosis. One died about two months after operation due to tumor metastasis and diffusion, and the remaining 12 patients survived. The radiolucent line happened in 2 of 12 cases, but there was no osteolysis, prosthesis loosening, dislocation or femoral stem subsidence. According to WHO standard for therapeutic effect of cancer, complete pain relief was achieved in 2 cases, significant relief in 6, partial relief in 3 and no relief in 1 ; the total remission rate was 91.7%. According to the Enneking functional scoring system, the patients were rated as excellent in 3 good in 5, fair in 3 and poor in 1, and the excellent and good rate was 66.7%. Postoperative quality life was excellent in 6 cases and good in 3 cases according to Kanofsky score, and the total effective rate was 75%. The results indicate that artificial prosthesis replacement for metastatic tumors involving the proximal femur could lead to remarked improvement in pain relie
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2009年第9期1747-1750,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
