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

发布时间：2018-08-19 12:08

【摘要】：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 m L;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。
[Abstract]:Objective to investigate the clinical effect of large segment allograft single condylar replacement for reconstruction of bone defect after resection of bone tumor around knee joint. Methods from January 2007 to January 2014, the clinical data of 9 patients with bone tumor around knee joint treated by large segment allograft single condyle replacement were retrospectively analyzed. There were 6 males and 3 females with an average age of 25.8 years. There were 7 cases of giant cell tumor of bone (1 case of recurrence of giant cell tumor of bone) and 2 cases of chondromyxoid fibroma. The tumor was located in 7 cases of distal femur and 2 cases of proximal tibia. The duration of symptoms was 2 ~ 5 months (mean 3.2 months). X-ray and MRI examinations were performed before operation, and 6 cm 脳 2 cm~9 cm 脳 4 cm CT scan was performed to exclude lung metastasis. The length of single condylar allograft was 8.0 ~ 9.2 cm, with an average of 8.6 cm. Results the amount of intraoperative bleeding was 400 ~ 550 mL with an average of 480 mL. The continuous exudation occurred in the incision after extubation of the drainage tube and healed in 3 months. All the other patients were followed up in the first stage of incision healing at 2 weeks after operation. The follow-up time was 3 ~ 10 years (mean 6 years). During the follow-up, no infection occurred, no allogeneic bone union and rupture occurred. One year after operation, the range of motion of the knee joint was 90 掳, the average was 100 掳, the (MSTS) score of the society of musculoskeletal neoplasms was 24 ~ 29 points, the average score was 26 points. The X-ray film showed that there was a reduced area of bone density (osteolysis) in 6 cases of allograft bone, no collapse of the articular surface, fracture or fracture occurred. Callus was formed between allogeneic bone and host bone interface, and cortical bone had good continuity. Conclusion after resection of bone tumor, large segment allograft single condyle replacement can provide good support and function, and obtain satisfactory clinical effect.
【作者单位】：中国人民解放军总医院骨科;
【基金】：国家自然科学基金资助项目(81472513)~~
【分类号】：R738

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