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目的探讨恶性肿瘤假体置换患者术中应用人工补片修复关节囊及软组织的效果及价值。方法回顾总结2003年1月～2008年6月肩、髋和膝关节周围恶性肿瘤非病理骨折患者行关节置换且获随访者35例,男19例,女16例,年龄23～82岁,平均50岁。肩关节置换10例,髋关节置换18例,膝关节置换7例。骨转移瘤21例,分别为肱骨近端及股骨近端;原发恶性骨肿瘤14例。将患者术前、术后关节功能按MSTS关节功能评价系统进行评定。所有患者均实施肿瘤广泛切除加人工假体置换,术中以人工补片修复关节囊。术后早期开始评价关节功能并积极功能锻炼、随访观察。对患者术后的临床结果进行分析评价。结果全部患者平均随访22个月(6个月～68个月),平均于术后5d拔除引流管,伤口均Ⅰ期愈合,无术后感染,未发生假体脱位。术前关节功能按MSTS关节功能评价系统测定20例为良、15例为可;而术后28为良、7例为可。所有患者最后随访时对治疗结果满意。结论应用人工补片修复肿瘤关节假体置换后的关节囊及软组织,对软组织缺损后的关节稳定性和动力重建有重要作用,临床效果满意。
Objective To investigate the effect and value of artificial patch in repairing joint capsule and soft tissue in patients undergoing malignant tumor prosthesis replacement. Methods From January 2003 to June 2008, 35 patients with non-pathological fractures of the shoulder, hip and knee with non-pathological fracture underwent joint replacement and were followed up from January 2003 to June 2008. There were 19 males and 16 females, aged from 23 to 82 years 50 years old. Shoulder joint replacement in 10 cases, hip replacement in 18 cases, knee replacement in 7 cases. Bone metastases in 21 cases, respectively, the proximal humerus and proximal femur; primary malignant bone tumors in 14 cases. The patients’ preoperative and postoperative joint function were evaluated by MSTS joint function evaluation system. All patients underwent extensive resection of tumor plus artificial prosthesis replacement, intraoperative artificial patch to repair the joint capsule. Early postoperative evaluation of joint function and active functional exercise, follow-up observation. The patient’s postoperative clinical results were analyzed and evaluated. Results All patients were followed up for an average of 22 months (range, 6 months to 68 months). On average, the drainage tube was removed 5 days after operation. The wounds healed on stage I without any postoperative infection and no prosthesis dislocation occurred. Preoperative joint function by MSTS joint function evaluation system measured 20 cases were good, 15 cases can be; and 28 cases were good, 7 cases can be. All patients were satisfied with the outcome of the treatment at last follow-up. Conclusion Artificial patch repair of tumor joint prosthesis replacement of joint capsule and soft tissue, soft tissue defects after joint stability and dynamic reconstruction has an important role, the clinical effect is satisfactory.