腓骨小头切除对胫骨上段肿瘤保肢人工关节重建术的影响分析
发布时间：2018-10-04 21:12
【摘要】：目的： 探讨腓骨小头切除对胫骨上段肿瘤保肢治疗人工关节重建术的影响。方法： 1999年7月-2013年3月,76例胫骨上段骨肿瘤患者行保肢术。术中行瘤段切除、人工全膝关节重建,腓肠肌内侧头肌瓣敷盖,其中38例同时行腓骨小头切除(A组),38例保留腓骨小头(B组)。两组患者性别、年龄、侧别、肿瘤类型及分期、病程比较,差异无统计学差异,具有可比性。观察比较两组术后相关并发症发生情况,X线片观察假体位置,采用1993年美国骨肿瘤学会评分系统(MSTS93)评分系统评定关节功能。结果： 患者均获随访,随访时间12-150个月,平均87个月。术后A组1例(2.63%)发生皮下软组织层感染,显著低于B组6例(15.79%)(χ2=3.934,P=0.047)。A组1例(2.63%)、B组2例(5.26%)发生腓肠肌内侧头坏死。X线片复查示A组4例(10.53%)、B组6例(15.79%)发生假体松动。A组2例(5.26%)、B组4例(10.53%)存在膝关节不稳。A组3例(7.89%)、B组5例(13.16%)肿瘤局部复发,A组7例(18.42%)、B组6例(15.79%)发生远处转移,A组8例(21.05%)、B组7例(18.42%)死亡。术后6个月,根据MSTS93评分系统,A组获优23例,良10例,中3例,差2例,优良率为86.84%；B组获优21例,良11例,中3例,差3例,优良率为84.21%。两组优良率比较,差异无统计学意义(χ2=0.106,P=0.744)。结论： 胫骨上段肿瘤行保肢手术人工关节重建同时行腓骨小头切除术利于术中软组织覆盖,可减少植皮术创伤及相应并发症,降低术后感染率,术后关节稳定性、关节活动度良好。
[Abstract]:Objective: to investigate the effect of fibula microcephalectomy on prosthetic joint reconstruction for upper tibial tumor. Methods: from July 1999 to March 2013, 76 patients with upper tibial bone tumor underwent limb salvage. Resection of tumor segment, reconstruction of total knee joint, flap of medial gastrocnemius muscle were performed in 38 cases (group A) and preservation of small head of fibula in 38 cases (group B). There were no significant differences in sex, age, side, tumor type and stage, and course of disease between the two groups. The postoperative complications were observed and compared between the two groups. The location of prosthesis was observed by X-ray film. The articular function was evaluated by the American Society of Bone Oncology scoring system (MSTS93) in 1993. Results: all patients were followed up for 12-150 months (mean 87 months). One case (2.63%) developed subcutaneous soft tissue infection in group A after operation. It was significantly lower than that in group B (6 cases (15.79%). Group A (2.63%) and group B (2 cases (5.26%) had medial gastrocnemius head necrosis. X-ray examination showed 4 cases (10.53%) in group A, 6 cases (15.79%) in group B, 6 cases (15.79%) in group B, 2 cases (5.26%) in group B, 4 cases (10.53%) in group B and 3 cases (7.89%) in group B. 5 cases (13.16%) had local recurrence in group A (18.42%), 6 cases (15.79%) in group B had distant metastasis, 8 cases (21.05%) in group A and 7 cases (18.42%) in group B. Six months after operation, according to the MSTS93 scoring system, 23 cases were excellent, 10 cases were good, 3 cases were fair, 2 cases were poor, the excellent and good rate was 86.844B group (21 cases), good (11 cases), moderate (3 cases), poor (3 cases), and excellent and good rate (84.21%). There was no significant difference in the excellent and good rates between the two groups (蠂 ~ 2 = 0.106). Conclusion: artificial joint reconstruction and fibula microcephalectomy for upper tibial tumors are beneficial to soft tissue coverage during operation, which can reduce skin grafting trauma and related complications, reduce postoperative infection rate and postoperative joint stability. The motion of the joint is good.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R738.1
[Abstract]:Objective: to investigate the effect of fibula microcephalectomy on prosthetic joint reconstruction for upper tibial tumor. Methods: from July 1999 to March 2013, 76 patients with upper tibial bone tumor underwent limb salvage. Resection of tumor segment, reconstruction of total knee joint, flap of medial gastrocnemius muscle were performed in 38 cases (group A) and preservation of small head of fibula in 38 cases (group B). There were no significant differences in sex, age, side, tumor type and stage, and course of disease between the two groups. The postoperative complications were observed and compared between the two groups. The location of prosthesis was observed by X-ray film. The articular function was evaluated by the American Society of Bone Oncology scoring system (MSTS93) in 1993. Results: all patients were followed up for 12-150 months (mean 87 months). One case (2.63%) developed subcutaneous soft tissue infection in group A after operation. It was significantly lower than that in group B (6 cases (15.79%). Group A (2.63%) and group B (2 cases (5.26%) had medial gastrocnemius head necrosis. X-ray examination showed 4 cases (10.53%) in group A, 6 cases (15.79%) in group B, 6 cases (15.79%) in group B, 2 cases (5.26%) in group B, 4 cases (10.53%) in group B and 3 cases (7.89%) in group B. 5 cases (13.16%) had local recurrence in group A (18.42%), 6 cases (15.79%) in group B had distant metastasis, 8 cases (21.05%) in group A and 7 cases (18.42%) in group B. Six months after operation, according to the MSTS93 scoring system, 23 cases were excellent, 10 cases were good, 3 cases were fair, 2 cases were poor, the excellent and good rate was 86.844B group (21 cases), good (11 cases), moderate (3 cases), poor (3 cases), and excellent and good rate (84.21%). There was no significant difference in the excellent and good rates between the two groups (蠂 ~ 2 = 0.106). Conclusion: artificial joint reconstruction and fibula microcephalectomy for upper tibial tumors are beneficial to soft tissue coverage during operation, which can reduce skin grafting trauma and related complications, reduce postoperative infection rate and postoperative joint stability. The motion of the joint is good.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R738.1
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