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目的总结人工全髋关节置换术治疗股骨近端骨肿瘤的临床疗效。方法 2000年1月-2009年6月,采用广泛切除肿瘤后人工全髋关节置换术治疗17例股骨近端骨肿瘤患者。男11例,女6例;年龄38～65岁,平均52.6岁。病程3～485d,中位时间18d。骨肉瘤2例,软骨肉瘤2例,骨转移性肿瘤3例,骨巨细胞瘤6例,动脉瘤样骨囊肿1例,骨囊肿2例,骨囊肿复发1例。肿瘤大小范围为4cm×3cm～8cm×4cm。结果患者手术时间100～180min,平均138min;术中输血量600～1500mL,平均923mL;住院时间14～22d,平均16.5d。术后切口均Ⅰ期愈合,无感染、脱位、脂肪栓塞、深静脉血栓形成发生。17例均获随访,随访时间11～60个月,平均47.4个月。3例骨转移性肿瘤、1例骨肉瘤于出院后11～37个月因肿瘤肝、肺转移死亡。术后1年存活的16例根据Harris评分标准评定关节功能:获优5例,良8例,中2例,差1例。X线片均未见肿瘤复发、髋臼磨损、髋关节脱位、假体松动与假体周围骨折。结论人工全髋关节置换术治疗股骨近端骨肿瘤早期疗效满意,可以重建髋关节功能,肢体功能恢复快,并发症少。
Objective To summarize the clinical effects of total hip arthroplasty in the treatment of proximal femoral neoplasms. Methods From January 2000 to June 2009, 17 cases of proximal femoral bone tumor were treated with total hip arthroplasty after tumor excision. 11 males and 6 females; aged 38 to 65 years, mean 52.6 years old. Duration of 3 ~ 485d, the median time 18d. 2 cases of osteosarcoma, 2 cases of chondrosarcoma, 3 cases of bone metastases, 6 cases of giant cell tumor of bone, 1 case of aneurysmal bone cyst, 2 cases of bone cyst and 1 case of bone cyst recurrence. Tumor size range of 4cm × 3cm ~ 8cm × 4cm. Results The operation time ranged from 100 to 180 minutes, with an average of 138 minutes. The intraoperative blood transfusion volume was 600 to 1500 mL with an average of 923 mL. The length of hospital stay was 14 to 22 days with an average of 16.5 days. Postoperative incision healed by first intention without infection, dislocation, fat embolism and deep venous thrombosis. All 17 patients were followed up for 11 ~ 60 months with an average of 47.4 months. 3 cases of bone metastatic tumors, 1 case of osteosarcoma 11 to 37 months after discharge due to tumor liver and lung metastasis and death. Sixteen patients survived one year after surgery were evaluated for joint function based on the Harris score: 5 were excellent, 8 were good, 2 were fair, and 1 was poor. X-ray showed no tumor recurrence, acetabular wear, dislocation of the hip, prosthesis loosening and periprosthetic fractures. Conclusion The total hip arthroplasty in the treatment of proximal femoral bone tumors with early satisfactory results, can reconstruct the function of the hip, limb function recovered quickly, fewer complications.