论文部分内容阅读
目的探讨应用大段冷冻异体骨复合人工关节修复股骨肿瘤切除后骨缺损的疗效。方法自1997年6月~2003年10月采用大段同种异体骨复合人工关节治疗股骨肿瘤28例,其中复合股骨上段的全髋关节置换13例,复合股骨下段全膝关节置换15例。按Enneking分期,广泛边缘性切除肿瘤,选用长柄人工关节将大小和形态合适的同种异体骨与宿主骨经骨水泥髓内固定,假体柄插入宿主骨髓内长度与异体骨轴心长度比应在0.8以上。术后均未使用免疫抑制剂。结果28例中除2例复合股骨下段患者失访外,其余患者随访6～78个月,平均41个月。3例骨肉瘤患者于术后18个月内死亡;4例(恶性骨巨细胞瘤2例,皮质旁骨肉瘤和软骨肉瘤各1例)分别于术后8个月内局部软组织复发,经广泛切除后治愈;其余患者均无瘤生存。所有患者均无关节脱位、假体松动和断裂。9例异体股骨大转子区及6例股骨髁区部分吸收。24例异体骨和宿主骨间达骨性愈合,愈合时间为5～11个月,平均7.4个月。13例复合股骨上段的全髋关节置换者,髋关节主动活动度为71°～124°,平均85°;13例复合股骨下段全膝关节置换者,膝关节主动活动度为68°～135°,平均92°。按ISOLS骨肿瘤术后功能重建评分为22～28分,平均26.2分。结论现代骨水泥技术将人工关节、异体骨与宿主骨有机地连接在一起,达到早期牢
Objective To investigate the effect of using a large section of frozen allogeneic bone combined artificial joint in the repair of bone defect after resection of femoral tumor. Methods From June 1997 to October 2003, 28 cases of femoral tumor were treated with large bone allograft artificial joint, including 13 cases of total hip replacement in the upper femur and 15 cases of total knee replacement in the lower femur. According to Enneking staging, extensive marginal resection of the tumor, the use of long-stem artificial joint size and shape appropriate allogeneic bone and host bone cement by intramedullary fixation, prosthesis stem inserted into the host bone marrow length and allograft axial length ratio Should be above 0.8. No immunosuppressive agents were used after surgery. Results Among the 28 cases, 2 patients were followed up for 6 to 78 months with an average of 41 months except for the compound femur. Three patients with osteosarcoma died within 18 months after operation. Four patients (2 cases of malignant giant cell tumor, 1 case of para-skullosarcoma and 1 case of chondrosarcoma) underwent local soft tissue recurred within 8 months after operation. Cure after resection; other patients had tumor-free survival. All patients had no joint dislocation, prosthesis loosening and rupture. 9 cases of allogeneic femoral greater trochanter and 6 cases of femoral condyle partial absorption. 24 cases of allogeneic bone and the host bone between the bone healing, healing time is 5 to 11 months, an average of 7.4 months. Thirteen patients undergoing total hip arthroplasty with upper femur had active hip joint activity of 71 ° ~ 124 ° with an average of 85 °. Thirteen patients underwent total knee arthroplasty of the femur with active knee mobility of 68 ° -135 ° , An average of 92 °. According to ISOLS bone tumor postoperative functional reconstruction score of 22 to 28 points, an average of 26.2 points. Conclusion The modern bone cement technology will be artificial joints, allogeneic bone and the host organically connected together to achieve early prison