中国修复重建外科杂志

中国修复重建外科杂志

人工全股骨置换术治疗股骨恶性肿瘤

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目的 探讨人工全股骨置换术治疗股骨恶性肿瘤的手术方法和临床疗效。 方法 回顾分析 2013 年 7 月—2017 年 3 月行人工全股骨置换术治疗的 9 例股骨肿瘤患者临床资料,其中男 5 例,女 4 例;年龄 16~75 岁,平均 44.8 岁。病程 2~6 个月,平均 3.5 个月。骨肉瘤 5 例(Enneking ⅡB 期 3 例、Ⅲ期 2 例);恶性纤维肉瘤 1 例(Enneking ⅡB 期),软骨肉瘤 1 例(Enneking ⅠB 期),肺癌股骨多发转移伴病理性骨折 2 例。分别于术前及术后 3 个月采用疼痛视觉模拟评分(VAS)、肿瘤患者生活质量评分(QQL)评价其生活质量,末次随访时采用国际骨与软组织肿瘤协会(MSTS)评分和髋关节功能 Harris 评分(HHS)评价其功能。 结果 9 例患者均获随访,随访时间 11~58 个月,平均 21 个月。无伤口感染、关节脱位、神经损伤等并发症发生。1 例患者发生腘静脉血栓形成,2 例骨肉瘤患者肿瘤持续进展死亡。术后 3 个月 VAS 评分和 QQL 评分分别为(3.2±1.2)、(40.6±5.4)分,均较术前的(5.9±0.8)、(22.3±4.2)分显著改善(t=11.314,P=0.000;t=–7.794,P=0.000)。末次随访时 MSTS 评分为 15~29 分,平均 21.1 分;HHS 评分为 44~90 分,平均 66.5 分。 结论 人工全股骨置换术是治疗股骨恶性肿瘤的有效保肢方案,能够恢复肢体的负重和行走功能,提高生活质量。

Objective To investigate the procedure and effectiveness of total femoral replacement for treating malignant tumor. Methods The clinical data of 9 patients with femoral tumors who underwent total femoral replacement between July 2013 and March 2017 were retrospectively analyzed. There were 5 males and 4 females, aged from 16 to 75 years with an average of 44.8 years. The disease duration ranged from 2 to 6 months with an average of 3.5 months. There were 5 cases of osteosarcoma (3 cases were staged as Enneking ⅡB, 2 cases were staged as Enneking Ⅲ), 1 case of malignant fibrosarcoma (staged as Enneking ⅡB), 1 case of chondrosarcoma (staged as Enneking ⅠB), 2 cases of femoral muti-metastasis with pathological fracture. The visual analogue scale (VAS) score and the quality of life (QOL) score of the tumor patients were evaluated before operation and at 3 months after operation. The Musculoskeletal Tumor Society (MSTS) score and Harris hip score (HHS) were evaluated at last follow-up. Results Nine patients were followed up 11-58 months, with an average of 21 months. No complications such as wound infection, joint dislocation, and nerve injury occurred. One patient developed popliteal vein thrombosis, and 2 patients with osteosarcoma died of tumor progression. The VAS score and QQL score at 3 months after operation were 3.2±1.2 and 40.6±5.4 respectively, which were significantly improved when compared with preoperative ones (5.9±0.8 and 22.3±4.2 respectively) (t=11.314, P=0.000; t=–7.794, P=0.000). At last follow-up, the MSTS score was 15-29, with an average of 21.1, and the HHS score was 44-90, with an average of 66.5. Conclusion Total femoral replacement is an effective limb salvage procedure for the treatment of femur tumors, which can effectively restore the weight-bearing and walking function, and relieve and improve the quality of life.

关键词: 全股骨置换术; 股骨恶性肿瘤; 保肢

Key words: Total femoral replacement; femur malignant tumor; limb-salvage

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