膝关节周围骨巨细胞瘤人工关节置换术后疗效评价

发布时间：2019-03-13 09:29

【摘要】：目的分析膝关节周围骨巨细胞瘤(giant cell tumor,GCT)人工关节置换术后临床疗效。方法 2000年1月至2014年4月,第四军医大学西京医院骨肿瘤科采用瘤段切除+肿瘤型人工关节置换对25例膝关节周围GCT Campanacci III级及部分II级患者进行保肢手术治疗,其中男14例,女11例,年龄18~71岁,平均(43.2±11.1)岁。术后每3个月复查胸片和患肢正侧位X线片,采用Enneking评分标准评定患肢关节功能及假体存活率,统计分析患者性别、年龄、肿瘤部位、肿瘤分期、有无病理骨折与肿瘤复发的关系,分析肿瘤部位与假体松动的关系。结果 25例均获随访,随访时间20~168个月,平均(38.3±27.7)个月。根据Enneking骨肿瘤术后肢体功能的客观标准评价术后功能,优19例,良3例,中3例,差0例,优良率88%。25例中有5例出现假体无菌性松动或断裂,均为股骨GCT人工关节置换患者,且松动均发生于股骨端,使用时间为1年2个月、7年、10年(2例)、14年;1例术后2年行假体翻修,2例术后10年行假体翻修,1例术后4年出现关节活动受限,手术探查为股骨假体后侧瘢痕组织挛缩所致,行后关节囊松解术后恢复正常。性别上差异无统计学意义,且年龄、性别、发病部位、有无病理骨折及Campanacci分级、Enneking分期对肿瘤术后复发无明显影响。肿瘤部位对假体松动无明显意义。结论对GCT患者行瘤段切除+人工关节假体置换术,效果满意,但远期并发症多,降低复发率及并发症发生率是以后研究的重点。
[Abstract]:Objective to analyze the clinical results after arthroplasty for giant cell tumor of bone (giant cell tumor,GCT) around the knee joint. Methods from January 2000 to April 2014, 25 patients (14 males) with GCT Campanacci III grade and partial II grade around knee joint were treated with tumor resection and tumor artificial arthroplasty in the Department of Bone Oncology, Xijing Hospital, fourth military Medical University. There were 11 female cases (18 / 71 years old, mean (43.2 卤11.1) years old). Chest radiographs and ortholateral X-ray films of the affected limbs were reviewed every 3 months after operation. The joint function and prosthetic survival rate of the affected limbs were assessed by Enneking scoring standard. The patients' gender, age, tumor location and tumor stage were statistically analyzed. The relationship between pathological fracture and recurrence of tumor was analyzed, and the relationship between the location of tumor and loosening of prosthesis was analyzed. Results all 25 cases were followed up for a mean of (38.3 卤27.7) months, and the follow-up time was 20 months (168 months, mean (38.3 卤27.7) months). According to the objective criteria of limb function after Enneking bone tumor operation, the postoperative function was evaluated as excellent in 19 cases, good in 3 cases, moderate in 3 cases, poor in 0 cases, excellent and good rate of 88%. 5 of 25 cases showed aseptic loosening or rupture of prosthesis. All patients were treated with femoral GCT arthroplasty, and loosening occurred at the end of femur for 1 year, 2 months, 7 years, 10 years (2 cases), 14 years, and the duration of operation was 1 year and 2 months, 7 years, 10 years (2 cases). One case underwent prosthetic revision 2 years after operation, 2 cases underwent prosthesis revision 10 years after operation, and 1 case had limited joint activity at 4 years after operation. The operative exploration was caused by contracture of scar tissue in the posterior part of femoral prosthesis and recovered to normal after posterior arthroplasty. There was no significant difference in sex, age, sex, location of disease, pathological fracture, Campanacci grade and Enneking stage, which had no significant effect on postoperative recurrence of tumor. The location of the tumor had no significant effect on the loosening of the prosthesis. Conclusion for patients with GCT, the results are satisfactory, but there are many long-term complications. Reducing the recurrence rate and the incidence of complications is the focus of future research.
【作者单位】：解放军第四军医大学西京医院骨肿瘤科;
【分类号】：R738.1

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