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目的从肿瘤预后、假体生存、功能以及手术并发症角度评价股骨近段肿瘤切除、双动型股骨近段假体置换的效果。方法 2001年7月-2010年7月,对96例股骨近段肿瘤患者行肿瘤切除、双动型股骨近段假体置换术。男50例,女46例;年龄15～69岁,平均43.2岁。其中股骨近段骨肿瘤83例,大腿软组织肉瘤累及股骨近段13例。85例采用股骨近段肿瘤型假体,11例使用灭活骨-人工假体复合物重建缺损。根据Enneking分期,ⅠA、ⅠB期以及良性病变24例为A组,ⅡA、ⅡB期56例为B组,Ⅲ期原发肿瘤、骨髓瘤、淋巴瘤16例为C组。术后下肢功能采用1993年美国骨肿瘤学会评分(MSTS93)系统进行评估。结果 93例患者术后切口Ⅰ期愈合;3例切口未愈,行清创后全部愈合。89例获随访,随访时间1～10年,中位时间6.5年。随访期间死亡28例,均死于肿瘤疾病。A组患者5年和10年累积生存率均为100%,B组分别为56.5%和41.5%,C组5年累积生存率为18.4%;各组间比较差异均有统计学意义(P<0.01)。假体的5年和10年累积生存率分别为74.4%和62.5%,高于B、C组患者的5年和10年累积生存率(P<0.01)。61例存活患者功能随访时间为1～10年,平均4.7年;末次随访时MSTS93评分为63%～95%,平均79%。15例(16.9%)出现术后并发症:2例髋关节脱位,2例假体迟发性感染,8例假体无菌性松动,1例髋臼严重磨损、股骨头向髋臼内上移位,2例髋部痛疼、行走困难。结论双动型股骨近段假体治疗股骨近段肿瘤可使患者获得良好功能,尤其适用于EnnekingⅡ、Ⅲ期及骨髓瘤和淋巴瘤患者;但后期可能因假体无菌性松动、髋臼磨损以及髋部疼痛而需行翻修。
Objective To evaluate the effect of proximal femoral tumor resection and double-action femoral prosthesis replacement from the perspective of tumor prognosis, prosthesis survival, function and surgical complications. Methods From July 2001 to July 2010, 96 patients with proximal femur tumor underwent resection of the tumor and double-acting proximal femoral prosthesis replacement. 50 males and 46 females; aged 15 to 69 years, mean 43.2 years old. 83 cases of proximal femur bone tumors, 13 cases of thigh soft tissue sarcoma involving the proximal femur. 85 cases of proximal femoral tumor prosthesis, 11 cases of using inactivated bone - artificial prosthesis complex reconstruction defect. According to Enneking staging, 24 cases of stage IA, IB and benign lesions were group A, 56 cases of stage IIA and IIB were group B, and stage III primary tumors, myeloma and lymphoma were group C, 16 cases. Postoperative lower extremity function using the 1993 American Society of Bone Tumors (MSTS93) system for evaluation. Results Ninety-three patients underwent primary incision healing after operation. Three patients underwent incision healed, all of them were healed after debridement. 89 cases were followed up for 1 to 10 years, the median time was 6.5 years. During the follow-up period, 28 patients died of tumor diseases. The 5-year and 10-year cumulative survival rates were 100% in group A, 56.5% in group B and 41.5% in group A, respectively, and the 5-year cumulative survival rate in group C was 18.4%. The difference between groups was statistically significant (P < 0.01). The 5-year and 10-year cumulative survival rates of the prostheses were 74.4% and 62.5%, respectively, higher than those of the B and C groups (P <0.01). The survival of 61 survivors was followed up for 1 to 10 years with a mean of 4.7 years. The MSTS93 score at the final follow-up was 63% -95% with an average of 79%. Fifteen patients (16.9%) had postoperative complications: 2 cases of dislocation of the hip, 2 cases of delayed infection of prosthesis, 8 cases of prosthetic aseptic loosening, 1 case of severe acetabular wear and femoral head upwards in the acetabulum , 2 cases of hip pain, walking difficulties. Conclusion Double-acting proximal femoral prosthesis can be used to treat patients with advanced proximal femoral tumors, especially for Enneking Ⅱ, Ⅲ and myeloma and lymphoma patients; but the latter may be due to prosthesis aseptic loosening, acetabular wear As well as hip pain and need to be renovated.