定制型人工关节置换治疗成人股骨远端肿瘤-临床医学论文.doc

fgjfgjfjgf感觉各家各户激光焊接皇冠假日同人图 作者：尚希福，周业金，胡飞，黄炎，戴鮨戎 【摘要】目的评价定制型人工关节在股骨远端肿瘤保肢术中的作用。方法回顾分析我院接受定制型人工关节置换进行保肢治疗的股骨远端肿瘤患者38例，其中良性肿瘤9例，分别是骨巨细胞瘤7例(复发性骨巨细胞瘤5例，骨折2例)，骨巨细胞瘤合并动脉瘤样骨囊肿1例，骨母细胞瘤1例；恶性肿瘤29例，分别是成骨性骨肉瘤16例，转移性肿瘤6例(骨折2例)，软骨肉瘤2例，恶性纤维组织细胞瘤3例(骨折1例)，纤维肉瘤1例，局灶性骨髓瘤1例。所有患者均使用国产定制型人工膝关节，铰链式17例，后稳定型21例。结果9例良性肿瘤患者1例失访，1例死于其他不相关疾病，其余7例病人随访时膝关节功能按Enneking制定的标准进行评定，优5例，良1例，差1例，保肢成功率为100％；29例恶性骨肿瘤患者，骨肉瘤患者失访7例，2例患者术后局部复发，行截肢术；其余20例患者生存期间膝关节功能优10例，良4例，差6例。7例效果评价差的病人为有6例为铰链式膝关节假体。结论定制型人工膝关节置换是一种较好的股骨远端肿瘤保肢方法。 【关键词】骨肿瘤；保肢治疗；人工关节；股骨远端 LimbSalvageManagementofDistalFemurTumorswithCustomProsthesis Abstract：ObjectiveToevaluatetheroleofthecustomkneeprosthesisinthelimbsalvageprocedureofdistalfemurtumors.MethodsThirtyEightpatientsofdistalfemurtumors(benigntumor，ninepatients；malignanttumors，twentyninepatients)treatedwithcustomkneeprothesiswereretrospectivelyreviewed.Thebenigntumorsincludedsevencasesofgiantcelltumors(fivecasesofrecurredgiantcelltumors，twowithpathologicfracture).Onecaseofgiantcelltumorwithaneurismalcyst，oneofosteoblastoma.Themalignanttumorsincludedosteogenicosteosarcoma(sixteenpatients)，metastasistumor(sixpatients，twowithpathologicfractures)，chondrosarcoma(twopatients)，malignantfibroushistiocytoma(threepatients，onewithpathologicfracture)，fibrosarcoma(onepatient)，andsolitarymyeloma(onepatient).allpatientsrecEIvedlimbsavageprocedurewithcustomkneeprosthesisincludingsevnteencasesofhingejointandtwentyonecasesofposteriorstabilityjoints.ResultsOneofninepatientswithbenigntumorswaslostforfollowedup，onepatientdiedofunrelateddisease，theremainedpatientshaveexcellentfunctioninfivepatients，goodfunctioninonecase，andonepooraccordingtotheEnnekingevaluatingsystem.thelimbsalvageratewas100％.Sevenpatientswerelostforfollowedupintwentynineofmalignanttumors，twopatientwithmalignantfibroushistiocytomareceivedamputationduetolocalrecurrenceninemonthspostoperatively.Tenpatientshadexcellentfunction，fourgoodandsixpooramongthefolloweduppatients.Thetypeofprosthesisinsixofallpatientswithpoorfunctionwashinge.Con