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目的 探讨引起股骨远端骨肿瘤假体置换术后非肿瘤复发性失败的原因及其处理方法.方法 回顾2006年1月至2013年12月于我院治疗的78例股骨远端骨肿瘤患者.其中58例骨肉瘤、16例骨巨细胞瘤及4例其它骨与软组织肿瘤.初次手术为保肢手术,所用假体为组配水泥型假体.对出现的感染、假体障碍及无菌性松动等非肿瘤复发因素并发症进行二次手术并随访.结果 78例患者出现了6例无菌性松动、3例深部感染、3例软组织愈合不良和1例假体部件脱位.13例为男9例,女4例,出现并发症的平均年龄为25.6(16~37)岁.至随访终点,共计有10例假体失败,总体假体的5年预期生存率为81.4%.对无菌性假体松动病例分析发现,患者初次假体置换术后2个月恢复功能活动的体重指数(BMI)及患者切除肿瘤后骨缺损占比(尤其>40%)是引起假体无菌性松动的独立因素.同时6例无菌性松动患者的平均年龄为27.1岁,进行危险因子分析发现年龄 40% were independent risky factors of aseptic loosening which could result in prosthesis failure. The mean age of the 6 patients with aseptic loosening was 27.1 years. More athletic younger patients ( < 40 years ) were prone to incur the incidence of aseptic loosening ( P = 0.197 ). Deep infection happened to 3 patients within the first month after primary surgery, of whom, 2 patients received second-stage revision after removing the prosthesis and 1 patient accepted amputation. The patient with dislocated component at the second month after surgery received open reduction immediately. Six patients with aseptic loosening underwent revision with new custom cemented prosthesis with additional stem length ( average:5.2 cm, range: 4 - 6 cm ) and wider diameter. The average follow-up from the primary operation to the incidence of complications was 45 months ( range: 28 - 75 months ). The average MSTS score raised from 14.3 ( range: 12 -17 ) before revision to 28.5 ( range: 27 - 30 ) after an average follow-up of 34.3 months ( range: 18 - 58 months ). No incidence of complications was recorded after reoperation. Conclusions Aseptic loosening is the major non-recurrent factor of the failed tumor prosthesis in the distal femur and satisfactory outcomes can be gained after revision with new custom cemented prosthesis with longer stem length and wider diameter.