摘要
目的回顾性分析不同手术方式对累及膝关节周围恶性骨肿瘤患者的生存率、功能和外观的影响。方法 2010年1月至2015年12月,83例累及膝关节周围恶性骨肿瘤患者在我中心接受保肢治疗,骨肉瘤78例,尤文肉瘤5例。男50例,女33例,平均18.4(8~57)岁。Enneking外科分期:IB期1例,IIA期3例,IIB期77例,III期2例。累及股骨远端48例,累及胫骨近端35例。接受人工膝关节置换54例,接受保留骨骺或部分保留骨骺自体腓骨瓣复合异体骨重建17例,接受同种异体半髁或半胫骨平台重建10例,接受保留或部分保留骨骺同种异体大段异体骨重建2例。依据MSTS(1993)功能评分系统对各类重建手术进行评分。结果本组83例均获随访8~76个月,平均24个月。22例死亡,其中III期2例全部死亡,IIB期77例死亡20例,IIA期3例,48例无瘤存活。33例(39%)术后出现了肺转移或者其它部位多发转移,17例(20%)局部复发。Kaplan-Meier曲线分析患者生3年生存率为62.7%,5年生存率为49%。MSTS评分:平均24.5分,人工肿瘤膝关节置换患者平均23分,自体腓骨瓣复合异体骨重建患者平均25分,接受同种异体半髁或半胫骨平台患者平均26.7分。结论保肢治疗已经成为膝关节周围恶性肿瘤治疗的主要方式。人工肿瘤膝关节置换是主要的重建方式保肢成功率81.5%;自体腓骨瓣复合大段异体骨重建可以减少骨不连及延迟愈合;半髁或半胫骨平台切除同种异体半髁或半胫骨平台重建的适应证病变较局限的预期生存期较长的患者,术后膝关节功能恢复良好,但须在保证安全边界前提下,严格掌握适应证。
Objective To retrospectively analyze the survival rate and functional and oncological results of different limb salvage strategies for malignant bone tumors around the knee. Methods We retrospectively reviewed 83 patients with malignant bone tumors around the knee who underwent limb salvage in our department from January 2010 to December 2015. The preoperative diagnoses were osteosarcoma in 78 patients and Ewing＇s sarcoma in 5 patients. There were 50 males and 33 females and the mean age was 18.4 years （ range： 8 - 57 years ）. According to Enneking surgical staging system： stage IB in I case, stage IIA in 3 cases, stage IIB in 77 cases and stage III in 2 cases. The tumors were located at the distal femur in 48 cases and at the proximal tibia in 35 cases. Among them, 54 patients received reconstruction with prosthesis; 17 patients received reconstruction with epiphyseal preservation and allograft and vascularized fibular flap transplantation; 10 patients received reconstruction with unicondylar osteoallograft-prosthesis composite or unicondylar osteoarticular allograft; 2 patients received reconstruction with epiphyseal preservation and massive allograft bone transplantation. The function was documented according to MSTS （ 1993 ） functional scoring system. Results The median follow-up was 24 months （ range： 8 - 76 months ） in all the patients. At the latest follow-up, 22 patients died of tumor-related causes without reconstruction failure, including 2 patients of stage III, 20 patients of stage IIB and 3 patients of stage IIA. Forty-eight patients survived without tumors. Thirty-three （ 39% ） patients developed pulmonary metastasis or multiple bone metastases, and 17 （ 20% ） patients developed local recurrence. The Kaplan-Meier survival analysis showed the 3-year survival rate was 62.7% and the 5-year survival rate was 49%. The average MSTS functional score at latest follow-up was 24.5, and the average score of reconstruction with prosthesis was 23. The average score of reconstruction with allograft and vascularized fibular flap was 25, and the average score of reconstruction with unicondylar osteoallograft-prosthesis composite or unicondylar osteoarticular allograft was 26.7. Conclusions Limb salvage has become the main treatment strategy for malignant tumors around the knee joint. The limb salvage success rate can reach 81.5% in the treatment of reconstruction with prosthesis. Bone nonunion and delayed healing can be avoided in the treatment of reconstruction with allograft and vasculafized fibular flap. For the patients with limited lesions and expecting a longer survival time, the treatment of reconstruction with unicondylar osteoallograft-prosthesis composite or unicondylar osteoarticular allograft is a good choice. On the premise of safe margin, it can maximally recover the knee joint function. However, the surgical indications shouldbe strictly chosen.
出处
《中国骨与关节杂志》
CAS
2017年第6期428-432,共5页
Chinese Journal of Bone and Joint
关键词
膝关节
骨肉瘤
股骨
胫骨
关节成形术
置换
膝
骨重建
回顾性研究
Knee joint
Osteosarcoma
Femur
Tibia
Arthroplasty, replacement, knee
Bone remodeling
Retrospective studies
