摘要
目的通过对膝关节定制型肿瘤假体的翻修进行回顾性分析,总结手术技术和翻修原因,明确翻修术后并发症的发生,以及假体生存和功能情况。方法回顾性分析2002年6月-2007年6月收治的33例膝关节定制型肿瘤假体置换术后再次翻修患者的临床资料。其中男17例,女16例;年龄16～67岁,平均33.1岁。骨肉瘤17例,骨巨细胞瘤11例,骨恶性纤维组织细胞瘤2例,软骨肉瘤、滑膜肉瘤、脂肪肉瘤各1例。肿瘤部位:股骨远端22例,胫骨近端11例。翻修术与置换术间隔时间为6～180个月,平均45.3个月。翻修原因:肿瘤局部复发2例,假体周围感染8例,假体无菌性松动7例,创伤后假体周围骨折伴松动1例,假体柄折断6例,假体铰链机构失败9例。6例假体周围感染者,将原假体取出后行二期假体翻修;其余患者均行一期翻修。翻修假体均采用骨水泥固定假体,其中2例残留髓腔长度短于翻修假体柄,用异体骨段移植复合假体植入。结果17例两次手术均于同一医院进行的患者,首次置换手术时间为(149.8±40.5)min,翻修术为(189.9±43.8)min;置换术出血量为(605.2±308.0)mL,翻修术为(834.1±429.9)mL;以上指标比较差异均有统计学意义(P<0.05)。患者术后均获随访,随访时间12～76个月,平均45.1个月。2例行异体骨移植者分别于术后1年半和2年达骨性愈合。3例于翻修术后12～24个月死于肺转移;3例发生肺转移,随访期间带瘤生存。术后30例存活患者9例出现并发症,发生率为30%;其中浅表感染2例,深部感染5例,机械性并发症2例。7例发生假体失败,失败率为23.3%。Kaplan-Meier生存曲线分析翻修假体5年生存率为68.6%。翻修术前患者肢体功能根据1993年美国骨肿瘤学会评分系统(MSTS93)评分为57.1%±10.6%,术后6个月为73.6%±14.4%,差异有统计学意义(P<0.01)。结论膝关节定制型肿瘤假体的翻修主要原因是机械性问题和感染,翻修手术虽较复杂,具有一定并发症,但可保留大部分患者的肢体并恢复其功能。
Objective To evaluate the surgical skill,cause of revision,complications,prosthetic survival and postoperative function in revision of custom-made tumor prosthesis replacement of knee joint.Methods The clinical dataof 33 patients who received prosthetic revision surgery between June 2002 and June 2007 were reviewed.There were 17 malesand 16 females with an average age of 33.1 years（range,16-67 years）.The pathological diagnosis included 17 osteosarcomas,11giant cell tumors,2 malignant fibrous histocytomas,1 chondrosarcoma,1 synovial sarcoma,and 1 liposarcoma.The involved locations were distal femur in 22 cases and proximal tibia in 11 cases.The average interval between first prosthetic replacementand revision surgery was 45.3 months（range,6-180 months）.The reason for revision included local recurrence in 2 cases,deep infection in 8 cases,aseptic loosening in 7 cases,periprosthetic fracture in 1 case,prosthetic stem fracture in 6 cases,and prosthetic hinge failure in 9 cases.Six patients with deep infection received two-stage revision surgery,while the other 27patients received one-stage revision.Cemented prostheses were used in all patients.Allograft prosthetic composite and revisionswere used in 2 patients who had deficit of diaphysis for stem fixation.Results In 17 patients who received both primaryprosthetic replacement and revision,the operative time was（149.8±40.5）minutes and（189.9±43.8）minutes,and the bloodloss was（605.2±308.0）mL and（834.1±429.9）mL for primary prosthetic replacement and revision,respectively;all showingstatistically significant differences（P0.05）.The mean time of follow-up was 45.1 months（range,12-76 months）.Healingbetween allograft and host bone was obtained in 2 patients with allograft prosthetic composite and revision after 1.5 years and2 years,respectively.After revision surgery,3 patients died of lung metastasis after 12-24 months,and other 3 patients havinglung metastasis were alive with disease.Nine（30%）complications occurred in 30 patients who were alive at last follow-up.The complications included wound infection in 2 patients,deep infection in 5 patients,mechanical problems in 2 patients.Prosthetic failure occurred in 7 patients（23.3%）.The 5-year survival rate of revised prosthesis was 68.6%.The MusculoskeletalTumor Society（MSTS）score at 6 months after revision（73.6%±14.4%）was significantly improved（P0.01）when compared with before revision（57.1%±10.6%）.Conclusion The main reasons for revision of custom-made tumor prosthesis of knee joint were mechanical problems and deep infection.Although revision surgery of knee is relatively complicated and has some complications,a functional limb could be maintained in most tumor patients.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2010年第1期5-10,共6页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
膝关节肿瘤
定制型关节假体
关节置换术
翻修术
Tumor of knee joint Custom-made prosthesis Total hip arthroplasty Revision surgery
