Orthofix单边外固定架在骨肿瘤外科治疗中的应用

发布时间：2018-11-15 19:54

【摘要】：目的探讨Orthofix单边外固定架在骨肿瘤外科治疗中的应用特点及初步临床效果。方法回顾分析2011年6月—2016年3月因原发良、恶性骨肿瘤接受外科治疗并应用Orthofix单边外固定架的22例患者临床资料。男11例,女11例;年龄4~57岁,中位年龄23.5岁。肿瘤切除后骨缺损或肢体短缩部位:股骨上段6例,股骨下段8例,股骨中段3例,胫骨上段2例,胫骨中段3例。外固定架应用情况:骨缺损重建后临时固定10例(骨缺损长度6~19 cm,平均12.3 cm;采用带血管蒂腓骨移植2例,同种异体骨+游离腓骨移植2例,同种异体骨+自体骨移植5例,同种异体骨重建1例);肢体短缩行骨延长5例(短缩长度6.5~8.5 cm,平均7.5 cm);3例术前活检无法明确诊断,行切开活检,为预防病理骨折临时采用外固定架固定;肿瘤切除后骨缺损应用骨搬运1例(骨缺损长度7.5 cm);病理骨折术前化疗临时固定1例;股骨远端骨肉瘤行海扶刀治疗后,膝关节严重屈曲畸形伴关节脱位矫形2例。结果 22例患者均获随访,随访时间12~72个月,平均36个月。10例骨缺损重建患者带架时间3~8个月,平均4.8个月;均获满意骨愈合,愈合时间3~16个月,平均6.4个月;末次随访时国际保肢学会功能评分93版(MSTS 93)评分为73.3~93.3分,平均87.2分;患者佩戴外固定架期间未出现并发症。5例骨延长患者带架时间7~15个月;2例延长过程中出现成角畸形,2例拆架后出现青枝骨折,CheckettsOtterburn外固定架钉道感染分级为轻度感染1级2例,2级1例;MSTS 93评分为80.0~96.7分,平均89.2分。其余患者均无相关并发症发生,膝关节及踝关节活动正常。结论 Orthofix单边外固定架可用于骨肿瘤切除后复杂缺损的固定,并可通过骨延长纠正儿童保肢术后肢体不等长问题。
[Abstract]:Objective to investigate the application and clinical effect of Orthofix unilateral external fixator in the surgical treatment of bone tumor. Methods from June 2011 to March 2016, 22 patients with benign and malignant bone tumors received surgical treatment and were treated with Orthofix unilateral external fixator. There were 11 males and 11 females, aged 457 years with a median age of 23.5 years. There were 6 cases of upper femur, 8 cases of lower femur, 3 cases of middle femur, 2 cases of upper tibia and 3 cases of middle tibia after resection of tumor. Application of external fixator: temporary fixation after bone defect reconstruction in 10 cases (bone defect length 619 cm, mean 12.3 cm;) Vascularized fibula transplantation was performed in 2 cases, free fibula allograft in 2 cases, autogenous bone transplantation in 5 cases and allograft bone reconstruction in 1 case. Bone lengthening was performed in 5 cases (6.5 cm, 8.5 cm, mean 7.5 cm);). The biopsy was performed in 3 cases without definite diagnosis, and external fixator was used to prevent pathological fracture. Bone defect was treated with bone transport in 1 case (bone defect length 7.5 cm);) and osteosarcoma of distal femur treated with Heft knife in 1 case, severe flexion deformity of the knee with dislocation of joint was performed in 2 cases. Results all the 22 patients were followed up for 12 ~ 72 months (mean 36 months), 10 patients with bone defect reconstruction had a time of 3 ~ 8 months (mean 4.8 months), all of them were satisfied with bone healing, the healing time was 3 ~ 16 months (mean 6.4 months). At the last follow-up, the score of MSTS 93 was 73.3 ~ 93.3, with an average of 87.2, and there was no complication during the period of external fixation. Angle deformities were found in 2 cases, green branch fractures were found in 2 cases after removal of frame, infection grade of CheckettsOtterburn external fixator was mild infection in 2 cases, grade 2 was grade 2, and MSTS 93 score was 80.096.7 points with an average of 89.2 points. The other patients had no related complications and normal knee and ankle joint activity. Conclusion Orthofix unilateral external fixator can be used to fix complex defects after bone tumor resection, and to correct limb unequal length after limb salvage in children by bone lengthening.
【作者单位】：北京大学人民医院骨与软组织肿瘤治疗中心骨与软组织肿瘤研究北京市重点实验室;
【分类号】：R738

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