定制型人工关节置换治疗成人股骨远端肿瘤_临床医学论文.docVIP

定制型人工关节置换治疗成人股骨远端肿瘤_临床医学论文 定制型人工关节置换治疗成人股骨远端肿瘤_临床医学论文 作者：尚希福，周业金，胡飞，黄炎，戴鮨戎 【摘要】 目的 评价定制型人工关节在股骨远端肿瘤保肢术中的作用。方法 回顾分析我院接受定制型人工关节置换进行保肢治疗的股骨远端肿瘤患者38 例，其中良性肿瘤9 例，分别是骨巨细胞瘤7 例(复发性骨巨细胞瘤5 例，骨折2 例)，骨巨细胞瘤合并动脉瘤样骨囊肿1 例，骨母细胞瘤1 例；恶性肿瘤29 例，分别是成骨性骨肉瘤16 例，转移性肿瘤6 例(骨折2 例)，软骨肉瘤2 例，恶性纤维组织细胞瘤3 例(骨折1 例)，纤维肉瘤1 例，局灶性骨髓瘤1 例。所有患者均使用国产定制型人工膝关节，铰链式17 例，后稳定型21 例。结果 9 例良性肿瘤患者1 例失访，1 例死于其他不相关疾病，其余7 例病人随访时膝关节功能按Enneking制定的标准进行评定，优5 例，良1 例，差1 例，保肢成功率为100％；29 例恶性骨肿瘤患者，骨肉瘤患者失访7 例，2 例患者术后局部复发，行截肢术；其余20 例患者生存期间膝关节功能优10 例，良4 例，差6 例。7 例效果评价差的病人为有6 例为铰链式膝关节假体。结论 定制型人工膝关节置换是一种较好的股骨远端肿瘤保肢方法。 【关键词】 骨肿瘤；保肢治疗；人工关节；股骨远端 Limb Salvage Management of Distal Femur Tumors with Custom Prosthesis Abstract：Objective To evaluate the role of the custom knee prosthesis in the limb salvage procedure of distal femur tumors.Methods Thirtyeight patients of distal femur tumors(benign tumor，nine patients；malignant tumors，twentyl tumors，two with pathologic fracture).One case of giant cell tumor with aneurismal cyst，one of osteoblastoma.The malignant tumors included osteogenic osteosarcoma(sixteen patients)，metastasis tumor(six patients，two with pathologic fractures)，chondrosarcoma(two patients)，malignant fibrous histiocytoma (three patients，one with pathologic fracture)，fibrosarcoma(one patient)，and solitary myeloma(one patient).all patients received limb savage procedure with custom knee prosthesis including sevnteen cases of hinge joint and twentyone cases of posterior stability joints.Results One of nine patients with benign tumors was lost for followedup，one patient died of unrelated disease，the remained patients have excellent function in five patients，good function in one case，and one poor according to the Enneking evaluating system.the limb salvage rate was 100％.Seven patients were lost for followed，two patient with malignant fibrous histiocytoma received amputation due to local recurrence nine months postoperatively.Ten patients had excellent function，four good and six poor among the followedf the optional methods of