摘要
目的探讨肿瘤型人工膝关节假体置换术治疗膝关节周围恶性骨肿瘤的效果、并发症及患者生存情况。方法回顾性分析2010年1月至2018年4月在山西医科大学第二医院行肿瘤型膝关节假体置换术的47例患者资料,其中男性21例,女性26例,中位年龄21岁(7~70岁);骨肉瘤39例,软骨肉瘤3例,恶性纤维组织细胞瘤2例,骨巨细胞瘤2例,纤维肉瘤1例;肿瘤位于股骨远端者35例,胫骨近端者12例。骨肉瘤、恶性纤维组织细胞瘤患者术前均行2个疗程化疗,术后均行4~6个疗程化疗。收集资料包括患者生存时间、假体生存时间和并发症、肢体功能、肿瘤复发、肺转移等。结果患者中位随访25个月(5~102个月)。患者1、3、5年总生存率分别为95.74%、71.29%、58.06%,1、3、5年无瘤生存率分别为86.42%、55.49%、50.86%。10例(21.28%)患者术后3年内出现了肿瘤局部复发,其中8例为软组织肿瘤复发,行肿瘤再切除,其余2例行截肢术;15例(31.91%)发生肺转移。假体5年总生存率为82.33%,其中股骨远端肿瘤患者的假体5年总生存率高于胫骨近端患者(86.96%比75.00%,P=0.338);3例(6.38%)出现假体感染,1例(2.13%)假体松动后翻修,1例(2.13%)假体断裂后翻修。患者末次随访时国际骨与软组织肿瘤协会(MSTS)评分中位数(P25,P75)为21分(15分,24分),优良率为61.70%(29/47)。胫骨近端肿瘤患者伸膝延迟发生率高于股骨远端肿瘤患者,差异有统计学意义[33.33%(4/12)比2.86%(1/35),P=0.016]。结论肿瘤型人工膝关节假体置换术能够有效治疗膝关节周围恶性骨肿瘤,可保持满意的肢体功能和生存率,但术后相关并发症可导致保肢失败,需通过规范的放化疗、广泛严格的肿瘤切除及适当的康复锻炼来减少并发症的发生。
Objective To investigate the effects,complications and survival of patients tumor-type artificial knee prosthesis replacement for treatment of malignant bone tumors around the knee.Methods The data of 47 patients undergoing tumor-type knee prosthesis replacement in Shanxi Medical University from January 2010 to April 2018 was retrospectively analyzed.There were 21 males and 26 females,with a median age of 21 years(7-70 years).There were 39 cases of osteosarcomas,3 cases of chondrosarcomas,2 cases of malignant fibrous histiocytomas,2 cases of giant cell bone tumors,and 1 case of fibrosarcoma.The involved locations were the distal femur in 35 cases and proximal tibia in 12 cases.Patients with osteosarcoma and malignant fibrous histiocytomas received chemotherapy for 2 courses before operation and 4-6 courses after operation.The data included the survival time,prosthesis survival time,complications,limb function,tumor recurrence and lung metastasis of patients.Results Patients were followed up for a median time of 25 months(5-102 months).The 1-year,3-year and 5-year overall survival rates were 95.74%,71.29% and 58.06%,respectively.The 1-year,3-year and 5-year disease-free survival rates were 86.42%,55.49% and 50.86%,respectively.Local tumor recurrence occurred in 10 patients(21.28%)within 3 years after operation.Of the 10 patients,8 cases had a recurrence of the soft tissue tumor and then they received the resection surgery;the other 2 patients underwent amputation of the diseased limb.The pulmonary metastasis occurred in 15 patients(31.91%).The 5-year survival rate of prosthesis was 82.33%,and the 5-year survival rate of prosthesis in patients with tumor in the distal femur was higher than that in patients with tumor in the proximal tibia[86.96%vs.75.00%,P=0.338].The periprosthetic infection occurred in 3 patients(6.38%),and 1 case(2.13%)received revision after prosthesis loosening,1 case(2.13%)received revision after prosthesis breakage.At the patient's last follow-up,the Musculoskeletal Tumor Society(MSTS)score w
作者
沈合毅
李立志
武壮壮
吕智
Shen Heyi;Li Lizhi;Wu Zhuangzhuang;Lyu Zhi(Department of Orthopedics,the Second Hospital of Shanxi Medical University,the Second Clinical Medical College of Shanxi Medical University,Taiyuan 030001,China)
出处
《肿瘤研究与临床》
CAS
2020年第10期718-723,共6页
Cancer Research and Clinic
关键词
膝关节
人工
骨肿瘤
关节成形术
置换
膝
手术后并发症
预后
Knee prosthesis
Bone neoplasms
Arthroplasty,replacement,knee
Postoperative complications
Prognosis
