中国修复重建外科杂志

中国修复重建外科杂志

大段同种异体骨单髁置换术治疗膝关节周围骨肿瘤疗效观察

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目的探讨应用大段同种异体骨单髁置换术重建膝关节周围骨肿瘤切除后骨缺损的临床疗效。方法回顾分析 2007 年 1 月—2014 年 1 月采用大段同种异体骨单髁置换术治疗的 9 例膝关节周围骨肿瘤患者临床资料。其中男 6 例,女 3 例;年龄 17~38 岁,平均 25.8 岁。骨巨细胞瘤 7 例(其中 1 例为骨巨细胞瘤术后复发),软骨黏液样纤维瘤 2 例。肿瘤位于股骨远端 7 例,胫骨近端 2 例;肿瘤部位均偏外侧。症状持续时间 2~5 个月,平均 3.2 个月。术前均行 X 线片和 MRI 检查,确定肿瘤范围 6 cm×2 cm~9 cm×4 cm;CT 检查排除肺部转移。术中置换的单髁同种异体骨长度为 8.0~9.2 cm,平均 8.6 cm。结果患者术中出血量为 400~550 mL,平均 480 mL;术后输注红细胞 0~3 U。1 例患者拔除引流管后出现切口处持续渗液,3 个月后愈合;其余患者术后 2 周切口均Ⅰ期愈合。9 例患者均获随访,随访时间 3~10 年,平均 6 年。随访期间无术区感染发生,无同种异体骨愈合不良和断裂发生。术后 1 年膝关节活动度为 90~110°,平均 100°;肌肉骨骼肿瘤学会(MSTS)评分为 24~29 分,平均 26 分。X 线片示同种异体骨内有密度减低区(骨溶解)6 例;无关节面塌陷、骨裂或骨折发生;同种异体骨与宿主骨接触面之间均有骨痂形成,皮质骨连续性良好。结论骨肿瘤切除后采用大段同种异体骨单髁置换重建,可提供良好支撑和功能,获得满意临床疗效。

ObjectiveTo analyze the effectiveness of unicompartment allografts replacement for reconstructing bone defect after bone tumor resection around knee.MethodsBetween January 2007 and January 2014, a total of 9 patients received unicompartment allografts replacement to treat bone tumor around the knee, including 6 males and 3 females, with an average age of 25.8 years (range, 17-38 years). There were 7 patients with bone giant cell tumor (postoperative recurrence of bone giant cell tumor in 1 case) and 2 patients with chondromyxoid fibroma. The tumors were located at the distal femur in 7 cases and proximal tibia in 2 cases, and the tumors were almost at the lateral limbs. The symptom duration was 2-5 months (mean, 3.2 months). The size of lesion ranged from 6 cm×2 cm to 9 cm×4 cm by X-ray film and MRI; and the metastasis was excluded by CT. The length of the allograft was 8.0-9.2 cm (mean, 8.6 cm).ResultsThe intraoperative blood loss volume was 400-550 mL (mean, 480 mL); and 0-3 U of erythrocyte was transfused after operation. The continuous exudate of incision occurred in 1 patient, and cured after 3 months; the other incisions healed primarily at 2 weeks after operation. All patients were followed up 3-10 years (mean, 6 years). No operation area infection, allograft bone poor healing or rupture was found. At 1 year after operation, the knee range of motion was 90-110° (mean, 100°); the Musculoskeletal Tumor Society score was 24-29 (mean, 26). Low density area (osteolysis) was found in 6 allografts; no articular surface collapse, hairline fracture, or fracture was found in patients; callus formation was observed in the contact surface between the allograft and the host bone, and the cortical bone showed good continuity.ConclusionUnicompartment allografts replacement can provide good support and function in terms of bone tumor resection, and achieve good effectiveness by biological reconstruction.

关键词: 骨肿瘤; 保肢术; 同种异体骨; 单髁置换术; 重建

Key words: Bone tumor; limb salvage; allogenic bone; unicompartmental arthroplasty; reconstruction

引用本文: 黄俊琪, 毕文志, 韩纲, 贾金鹏, 许猛, 王威. 大段同种异体骨单髁置换术治疗膝关节周围骨肿瘤疗效观察. 中国修复重建外科杂志, 2017, 31(8): 908-912. doi: 10.7507/1002-1892.201704044 复制

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