人工假体置换术在骨肿瘤治疗当中的应用
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摘要
目的:探讨人工假体置换术在骨肿瘤治疗中的应用。
方法:2000年至2008年,我科行肿瘤性假体置换术治疗长管状骨骨肿瘤25例,现将结果报下:
一般数据:全组25例,平均42岁。其中骨肉瘤7例、骨巨细胞瘤12例、滑膜肉瘤3例、软骨肉瘤1例、骨软骨瘤恶变1例,骨转移癌1例。病变部位:股骨头、颈及股骨上段7例、股骨远端8例、胫骨近端6例、全股骨1例、肱骨近端3例。按照Enneking标准骨肿瘤分期,ⅠB期8例、ⅡA期13例、ⅡB期4例,分别给予肿瘤性假体置换,包括股骨近端假体7例、铰链式膝关节14例、全股骨置换1例、肱骨近端及肩关节假体置换3例。
结果:本组25例病例术后给予随访2～80个月,局部复发3例,无瘤生存16例,2例患者发现远处转移, 4例患者死于原发疾病,1例患者出现感染情况经过对症治疗后好转,未发现假体松动的病例。术后依据1983年Enneking提出的保肢术术后功能评定标准来分析术后功能,本组优8例,良12例,可3例,差2例。
结论:骨肿瘤患者行肿瘤性人工假体置换术后肢体功能恢复好、辅以有效的化疗可以降低复发率、延长生命并提高患者的生存质量,是恶性骨肿瘤保肢治疗的一种较为理想的方法。
Objective:To evaluate application of prosthetic replacement in treatment of bone tumors.
Methods: Twenty-five patients with bone tumors were treated with en bloc resection and prosthetic replacemeng in our clinical division from the year of 2000 to 2008,average age is 42,including 7 patients with osteosarcoma,12 patients with giant cell tumor of bone,3 patients with synoviosarcoma,one patient with chondrosarcoma,one patient with carcinomatous change osteochondroma,one patient with osseous metastatic carcinoma. diseased region were as follow:7 tumors were situated in proximal end of femoral bone including collum femoris and caput femoris,8 tumors were situated in distal end of femoral bone,6 tumors were situated in proximal end of tibia,1 tumors was distributed almost all over the femoral bone,3 tumors were situated in proximal end of humeral bone.According to system for the surgical staging of musculoskeletal sarcoma created by Enneking,8 paticnts belonged toⅠB stage,13 paticnts belonged toⅡA stage,4 paticnts belonged toⅡB stage. The types of the prostheses included 7 proximal femoral prostheses,14 hinged knee prostheses,1 the whole femoral bone including articulatio coxae and articular genu prosthesis,3 proximal humeral prostheses.
Results :Twenty-five patients in the group were followed-up from 2 to 80 monthes. The local recurrence was seen in 3 patients, disease 16 patients survived without tumour cell, 2 patient was found tumor metastasis , 4 patients dead because of protopathy, among the total 1 patient with postoperative infection were recovered after symptomatic treatment,no prothesis looseness was found.
According to the system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal created by Enneking et al in 1993, excellent case was 8 ,good case was 12, fair case was 3, poor case was 2.
Conclusion:On the basis of the functional assessment after operation,we can find out that joint function of patients with bone tumor treated by prosthetic replacement recover well,moreover beside prolonging patients’life this mode of treatment can improve patients’quality of life,however there are some concurrent diseases such as postoperative infection,recurrence,prothesis looseness and so on,consequently we must grasp indication of prosthetic replacement,frame schema before operation perfectly,apply normative technique of surgical operations,take precautions against complication.Accompanying the development and innovation of medical science,Prosthetic Replacement has become a perfect limb salvage methods and the tendency in treatment of bone tumor.
方法:2000年至2008年,我科行肿瘤性假体置换术治疗长管状骨骨肿瘤25例,现将结果报下:
一般数据:全组25例,平均42岁。其中骨肉瘤7例、骨巨细胞瘤12例、滑膜肉瘤3例、软骨肉瘤1例、骨软骨瘤恶变1例,骨转移癌1例。病变部位:股骨头、颈及股骨上段7例、股骨远端8例、胫骨近端6例、全股骨1例、肱骨近端3例。按照Enneking标准骨肿瘤分期,ⅠB期8例、ⅡA期13例、ⅡB期4例,分别给予肿瘤性假体置换,包括股骨近端假体7例、铰链式膝关节14例、全股骨置换1例、肱骨近端及肩关节假体置换3例。
结果:本组25例病例术后给予随访2～80个月,局部复发3例,无瘤生存16例,2例患者发现远处转移, 4例患者死于原发疾病,1例患者出现感染情况经过对症治疗后好转,未发现假体松动的病例。术后依据1983年Enneking提出的保肢术术后功能评定标准来分析术后功能,本组优8例,良12例,可3例,差2例。
结论:骨肿瘤患者行肿瘤性人工假体置换术后肢体功能恢复好、辅以有效的化疗可以降低复发率、延长生命并提高患者的生存质量,是恶性骨肿瘤保肢治疗的一种较为理想的方法。
Objective:To evaluate application of prosthetic replacement in treatment of bone tumors.
Methods: Twenty-five patients with bone tumors were treated with en bloc resection and prosthetic replacemeng in our clinical division from the year of 2000 to 2008,average age is 42,including 7 patients with osteosarcoma,12 patients with giant cell tumor of bone,3 patients with synoviosarcoma,one patient with chondrosarcoma,one patient with carcinomatous change osteochondroma,one patient with osseous metastatic carcinoma. diseased region were as follow:7 tumors were situated in proximal end of femoral bone including collum femoris and caput femoris,8 tumors were situated in distal end of femoral bone,6 tumors were situated in proximal end of tibia,1 tumors was distributed almost all over the femoral bone,3 tumors were situated in proximal end of humeral bone.According to system for the surgical staging of musculoskeletal sarcoma created by Enneking,8 paticnts belonged toⅠB stage,13 paticnts belonged toⅡA stage,4 paticnts belonged toⅡB stage. The types of the prostheses included 7 proximal femoral prostheses,14 hinged knee prostheses,1 the whole femoral bone including articulatio coxae and articular genu prosthesis,3 proximal humeral prostheses.
Results :Twenty-five patients in the group were followed-up from 2 to 80 monthes. The local recurrence was seen in 3 patients, disease 16 patients survived without tumour cell, 2 patient was found tumor metastasis , 4 patients dead because of protopathy, among the total 1 patient with postoperative infection were recovered after symptomatic treatment,no prothesis looseness was found.
According to the system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal created by Enneking et al in 1993, excellent case was 8 ,good case was 12, fair case was 3, poor case was 2.
Conclusion:On the basis of the functional assessment after operation,we can find out that joint function of patients with bone tumor treated by prosthetic replacement recover well,moreover beside prolonging patients’life this mode of treatment can improve patients’quality of life,however there are some concurrent diseases such as postoperative infection,recurrence,prothesis looseness and so on,consequently we must grasp indication of prosthetic replacement,frame schema before operation perfectly,apply normative technique of surgical operations,take precautions against complication.Accompanying the development and innovation of medical science,Prosthetic Replacement has become a perfect limb salvage methods and the tendency in treatment of bone tumor.
引文
1、Enneking WF, Spanier SS ,Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop, 1980, 153: 106-116.
2、Enneking WF,Dunham W,Gelbhardt MC,et al.A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal systean.Clin Orthop, 1993,(286):241-246.
3、郑珂,肖泽浦,商冠宁. 人工假体在骨肿瘤保肢治疗中的应用. 实用肿瘤学杂志,2000, 14(4):298-299.
4、周忠,林建华. 人工特制假体在下肢骨肿瘤保肢治疗中的应用.中国骨肿瘤骨病,2006,5(2):90-94.
5、张鹤宇,王志义,罗先正 . 人工关节在骨肿瘤保肢治疗中的应用.中华骨科杂志, 2000, 20(7): 400-405.
6、李开华,于秀淳.恶性骨肿瘤保肢术的并发症原因与处理. 中国矫形外科杂志,2004,12(13): 1017-1019.
7、于秀淳,刘晓平,等.肿瘤型假体翻修手术的相关策略.中国矫形外科杂志 , 2006,14(17): 1294-1296.
8、陈述祥,赵崇达,刘红光,等. 特制人工假体在四肢骨肿瘤保肢治疗中的临床应用.中国骨伤, 2004,17(3):154-156.
9、马忠泰,粟怀广,高淑能,等.骨肉瘤患者的保留患肢治疗60 例报告.中华外科杂志,1995, 33( 2) : 82-84.
10、徐万鹏,郭卫,杨荣利,等.骨肿瘤的保肢术及其进展.中华骨科杂志,2000,(增刊):47-49.
1、 周忠,陈学明,王万明.股骨近端骨肿瘤切除后特制人工假体置换. 临床骨科杂志,2007,10(3):216-217.
2、Hsu R W,Sim F H,Chao E Y.Reperation results after segmental prosthetic replacement of bone and joint for limb salvage.J Arthroplasty,1999,14(5):19-26.
3、李伟栩,叶招明,等.骨肿瘤保肢手术中人工关节重建胫骨上端.实用肿瘤杂志, 2006,21(3):251-253.
4、Enneking WF,Spanier SS,Coodman MA.A system for the surgical staging of musculoskeletal sarcoma.Clin Orthop,1980,153: 106-116.
5、马忠泰,粟怀广,高淑能,等.骨肉瘤患者的保留肢治疗 60例报告.中华外科杂志, 1995,33(2):82-85.
6、李世德,张向敏,卓祥龙,等.半肩人工关节置换治疗肱骨上段肿瘤.中国骨肿瘤骨病,2005,4(1):15-18.
7、Brown TD, Bigliani LU. Complications with humeral head replacement.Orthop Clin North Am.2000. 31 (1):77-90.
8、李东升,张志勇,等.肱骨上段恶性肿瘤切除人工假体置换术.中国修复重建外科杂志,2006,20(10):996-998.
9、张光明,王建炜,等.人工肩关节置换治疗肱骨上段恶性骨肿瘤. 广东医学,200,27(2):159-161.
10、郭炜,李荣文,徐光辉,等.定制型人工髋关节置换治疗股骨近端瘤性病变.中国修复重建外科杂志,2006,20(10):989-991.
11、周忠,王万明,符臣学.股骨近关节端低度恶性肿瘤切除后的 人 工 关 节 置 换 术 . 中 国 修 复 重 建 外 科 杂志,2002,16(2) :103-105.
12、金今,费琦,邱贵兴,等.定制铰链型人工全膝假体在膝部恶性骨肿瘤保肢治疗中的临床应用.中国医刊, 2007,42(8):40-42.
13、阎作勤,谈绎文,等.膝关节周围恶性骨肿瘤不同保肢手术方法的比较.复旦学报(医学版),2004,31(4) :414-416.
14、陈述祥,赵崇达,等.特制人工假体在四肢骨肿瘤保肢治疗中的应用.中国骨伤,2004,17(3):154-156.
15、Kawai A, Healey JH,Boland PJ, etal. A rotating-binge knee replacement for malignant tumors of the femur and tibia. J Arthroplasty,1999, 14( 2):187- 96.
16、宋若先,于秀淳,刘晓平,等.人工全股骨置换治疗股骨干骨肉瘤并相关文献复习.中国矫形外科杂志,2004,12(13):972-974.
17、陈东峰.恶性骨肿瘤的保肢治疗及其进展.现代临床医学生物工程学杂志,2005,11(4):300-303.
18、Kulkarni SS,Dogra AS, Bhosale PB. Total hip arthroplasty for giant cell tumour.J Postgrad Med,1996,42(3):82-84.
19、王臻 马真胜,黄耀添,等.恶性骨肿瘤保肢手术后的骨关节返修术.中国修复重建外科杂志,2001, 15(1):5.
20、张光明,黄承达,韩仕英,等.恶性骨肿瘤保肢术局部复发相关问题研究.中国肿瘤临床,1996, 23:580.
21、Enneking W F,Dunham W,Gebhtadt M C,et al. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system.Clin Orthop,1993,286(1):241-246.
22、Tsuchiya H,Tomita K, Mori Y, et al. Marginal excision for osteo-sarcoma with caffine assisted chemotherapy. Clin Othop Relat Res 1999,(358): 27-35.
23、姜鹏翔,李建民.恶性骨肿瘤保肢手术并发症的原因及防治.临床骨科杂志, 2005 8(2):116-120.
24、李开华,于秀淳.恶性骨肿瘤保肢术的并发症原因与处理. 中国矫形外科杂志,2004,12(13): 1017-1019.
25、郭卫,姬涛,杨毅. 肿瘤型人工关节重建下肢骨肉瘤切除后的骨缺损. 中国修复重建外科杂志,2006,20(10):970-974.
26、董扬,蒋垚,等.人工关节在四肢恶性肿瘤功能重建中作用.临床骨科杂志,2006,9(6):502-503.
27、于秀淳,刘晓平,等.肿瘤型假体翻修手术的相关策略.中国矫形外科杂志 , 2 006,14(17): 1294-1296.
28、于秀淳,刘晓平,付志厚,等.肿瘤型假体置换术后再手术的原因与策略.中国修复重建外科杂志,2006,2(10):1011-1013.
29 、 Rosen G.Management of malignant bone tumors in children and adolescents. Pediatr Cain Sorth Am. 1976, 23(2): 183-213.
30、王鸥,王全明.新辅助化疗加保肢手术治疗肢体骨肉瘤.中国骨肿瘤骨病,2004,3(4):215-218 +225.
31、Fujii J,Ozaki T,Kawai A,et al. Angiography for assessment of preoperative chemotherapy in musculoskeletal sarcoma.Clin Ortlmp, 1999,(360):197.
32、Mochizuki K, Yamaguchi H, Umeda T. The management of pelvic chondrosarcoma in Japan. Japanese Musculo-Skeletal Oncology Group.Int Orthop, 2000, 24( 2):65.
33、孙明学,胡永成,冯林春,卢世璧.辅助放射治疗在恶性骨与软组织肿瘤治疗中的应用.中华骨科杂志,2000,20 卷增刊 :76-79.
34、刘铖,姚长海.后装放疗及其在骨与软组织肿瘤中的应用.临床骨科杂志:2001,4( 1):70-72.
35、郭乾臣,沈靖南.后装放疗和骨与软组织恶性肿瘤保肢. 滨州医学院学报,2005,28(1):30-33.
36、许建波,杨祚璋,肖砚斌.全股骨人工假体置换治疗右股骨骨肉瘤一例.中华肿瘤防治杂志,2007,14(3):239-240.
2、Enneking WF,Dunham W,Gelbhardt MC,et al.A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal systean.Clin Orthop, 1993,(286):241-246.
3、郑珂,肖泽浦,商冠宁. 人工假体在骨肿瘤保肢治疗中的应用. 实用肿瘤学杂志,2000, 14(4):298-299.
4、周忠,林建华. 人工特制假体在下肢骨肿瘤保肢治疗中的应用.中国骨肿瘤骨病,2006,5(2):90-94.
5、张鹤宇,王志义,罗先正 . 人工关节在骨肿瘤保肢治疗中的应用.中华骨科杂志, 2000, 20(7): 400-405.
6、李开华,于秀淳.恶性骨肿瘤保肢术的并发症原因与处理. 中国矫形外科杂志,2004,12(13): 1017-1019.
7、于秀淳,刘晓平,等.肿瘤型假体翻修手术的相关策略.中国矫形外科杂志 , 2006,14(17): 1294-1296.
8、陈述祥,赵崇达,刘红光,等. 特制人工假体在四肢骨肿瘤保肢治疗中的临床应用.中国骨伤, 2004,17(3):154-156.
9、马忠泰,粟怀广,高淑能,等.骨肉瘤患者的保留患肢治疗60 例报告.中华外科杂志,1995, 33( 2) : 82-84.
10、徐万鹏,郭卫,杨荣利,等.骨肿瘤的保肢术及其进展.中华骨科杂志,2000,(增刊):47-49.
1、 周忠,陈学明,王万明.股骨近端骨肿瘤切除后特制人工假体置换. 临床骨科杂志,2007,10(3):216-217.
2、Hsu R W,Sim F H,Chao E Y.Reperation results after segmental prosthetic replacement of bone and joint for limb salvage.J Arthroplasty,1999,14(5):19-26.
3、李伟栩,叶招明,等.骨肿瘤保肢手术中人工关节重建胫骨上端.实用肿瘤杂志, 2006,21(3):251-253.
4、Enneking WF,Spanier SS,Coodman MA.A system for the surgical staging of musculoskeletal sarcoma.Clin Orthop,1980,153: 106-116.
5、马忠泰,粟怀广,高淑能,等.骨肉瘤患者的保留肢治疗 60例报告.中华外科杂志, 1995,33(2):82-85.
6、李世德,张向敏,卓祥龙,等.半肩人工关节置换治疗肱骨上段肿瘤.中国骨肿瘤骨病,2005,4(1):15-18.
7、Brown TD, Bigliani LU. Complications with humeral head replacement.Orthop Clin North Am.2000. 31 (1):77-90.
8、李东升,张志勇,等.肱骨上段恶性肿瘤切除人工假体置换术.中国修复重建外科杂志,2006,20(10):996-998.
9、张光明,王建炜,等.人工肩关节置换治疗肱骨上段恶性骨肿瘤. 广东医学,200,27(2):159-161.
10、郭炜,李荣文,徐光辉,等.定制型人工髋关节置换治疗股骨近端瘤性病变.中国修复重建外科杂志,2006,20(10):989-991.
11、周忠,王万明,符臣学.股骨近关节端低度恶性肿瘤切除后的 人 工 关 节 置 换 术 . 中 国 修 复 重 建 外 科 杂志,2002,16(2) :103-105.
12、金今,费琦,邱贵兴,等.定制铰链型人工全膝假体在膝部恶性骨肿瘤保肢治疗中的临床应用.中国医刊, 2007,42(8):40-42.
13、阎作勤,谈绎文,等.膝关节周围恶性骨肿瘤不同保肢手术方法的比较.复旦学报(医学版),2004,31(4) :414-416.
14、陈述祥,赵崇达,等.特制人工假体在四肢骨肿瘤保肢治疗中的应用.中国骨伤,2004,17(3):154-156.
15、Kawai A, Healey JH,Boland PJ, etal. A rotating-binge knee replacement for malignant tumors of the femur and tibia. J Arthroplasty,1999, 14( 2):187- 96.
16、宋若先,于秀淳,刘晓平,等.人工全股骨置换治疗股骨干骨肉瘤并相关文献复习.中国矫形外科杂志,2004,12(13):972-974.
17、陈东峰.恶性骨肿瘤的保肢治疗及其进展.现代临床医学生物工程学杂志,2005,11(4):300-303.
18、Kulkarni SS,Dogra AS, Bhosale PB. Total hip arthroplasty for giant cell tumour.J Postgrad Med,1996,42(3):82-84.
19、王臻 马真胜,黄耀添,等.恶性骨肿瘤保肢手术后的骨关节返修术.中国修复重建外科杂志,2001, 15(1):5.
20、张光明,黄承达,韩仕英,等.恶性骨肿瘤保肢术局部复发相关问题研究.中国肿瘤临床,1996, 23:580.
21、Enneking W F,Dunham W,Gebhtadt M C,et al. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system.Clin Orthop,1993,286(1):241-246.
22、Tsuchiya H,Tomita K, Mori Y, et al. Marginal excision for osteo-sarcoma with caffine assisted chemotherapy. Clin Othop Relat Res 1999,(358): 27-35.
23、姜鹏翔,李建民.恶性骨肿瘤保肢手术并发症的原因及防治.临床骨科杂志, 2005 8(2):116-120.
24、李开华,于秀淳.恶性骨肿瘤保肢术的并发症原因与处理. 中国矫形外科杂志,2004,12(13): 1017-1019.
25、郭卫,姬涛,杨毅. 肿瘤型人工关节重建下肢骨肉瘤切除后的骨缺损. 中国修复重建外科杂志,2006,20(10):970-974.
26、董扬,蒋垚,等.人工关节在四肢恶性肿瘤功能重建中作用.临床骨科杂志,2006,9(6):502-503.
27、于秀淳,刘晓平,等.肿瘤型假体翻修手术的相关策略.中国矫形外科杂志 , 2 006,14(17): 1294-1296.
28、于秀淳,刘晓平,付志厚,等.肿瘤型假体置换术后再手术的原因与策略.中国修复重建外科杂志,2006,2(10):1011-1013.
29 、 Rosen G.Management of malignant bone tumors in children and adolescents. Pediatr Cain Sorth Am. 1976, 23(2): 183-213.
30、王鸥,王全明.新辅助化疗加保肢手术治疗肢体骨肉瘤.中国骨肿瘤骨病,2004,3(4):215-218 +225.
31、Fujii J,Ozaki T,Kawai A,et al. Angiography for assessment of preoperative chemotherapy in musculoskeletal sarcoma.Clin Ortlmp, 1999,(360):197.
32、Mochizuki K, Yamaguchi H, Umeda T. The management of pelvic chondrosarcoma in Japan. Japanese Musculo-Skeletal Oncology Group.Int Orthop, 2000, 24( 2):65.
33、孙明学,胡永成,冯林春,卢世璧.辅助放射治疗在恶性骨与软组织肿瘤治疗中的应用.中华骨科杂志,2000,20 卷增刊 :76-79.
34、刘铖,姚长海.后装放疗及其在骨与软组织肿瘤中的应用.临床骨科杂志:2001,4( 1):70-72.
35、郭乾臣,沈靖南.后装放疗和骨与软组织恶性肿瘤保肢. 滨州医学院学报,2005,28(1):30-33.
36、许建波,杨祚璋,肖砚斌.全股骨人工假体置换治疗右股骨骨肉瘤一例.中华肿瘤防治杂志,2007,14(3):239-240.