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目的探讨应用交锁髓内钉进行骨肿瘤术后功能重建的方法和疗效。方法 29例患者,男14例,女15例。年龄21～73岁,平均35.5岁。其中骨囊肿病理性骨折4例,骨纤维异常增殖症病理性骨折1例,非骨化性纤维瘤病理性骨折1例,骨转移癌病理性骨折8例,骨转移癌未骨折4例,骨肉瘤11例。病变位于肱骨3例,胫骨2例,股骨24例。采取切开复位交锁髓内钉固定14例,瘤段切除灭活再植交锁髓内钉固定9例,瘤段切除异体半关节移植交锁髓内钉固定2例,预防性交锁髓内钉内固定4例。结果随访12～48个月,切开复位内固定14例中,骨转移癌8例,术后死亡5例,1例术后肿瘤范围扩大,余2例基本恢复到骨折前功能状况,6例良性患者,术后无肿瘤复发,骨折均愈合;瘤段切除灭活再植9例中,术后死亡2例,肿瘤复发1例,截骨不愈合1例,余5例愈合;瘤段切除异体半关节移植2例中1例愈合,1例不愈合。4例预防性内固定中,1例术后1年内死亡,余3例术后功能良好。结论交锁髓内钉在病理骨折内固定,自体骨灭活再植及异体骨移植重建中具有对位容易,固定可靠,可早期功能锻炼等优点,应用骨转移癌预防性内固定可有效避免病理骨折的发生。
Objective To investigate the method and efficacy of interlocking intramedullary nailing for postoperative functional reconstruction of bone tumor. Methods 29 patients, 14 males and 15 females. Aged 21 ~ 73 years old, with an average of 35.5 years old. Among them, 4 cases of pathological fracture of bone cyst, 1 case of pathological fracture of fibrous dysplasia, 1 case of pathological fracture of non-ossifying fibromatosis, 8 cases of pathological fracture of bone metastasis, 4 cases of bone metastasis without fracture, 11 cases of tumor. Lesions in the humerus in 3 cases, 2 cases of tibia, femur in 24 cases. Twenty-four patients underwent open reduction and interlocking intramedullary nailing, 9 underwent resection and replanted intramedullary interlocking intramedullary nailing, 2 underwent resection of allogeneic joint with interlocking intramedullary nail, Nail internal fixation in 4 cases. Results During the follow-up of 12 to 48 months, 8 cases of bone metastases and 5 cases of postoperative death were treated by open reduction and internal fixation. One case had a wide range of tumor after operation, and the remaining 2 cases recovered to the functional status before fracture, and 6 cases Benign patients, no tumor recurrence after surgery, the fracture healed; tumor resection in 9 cases of inactivation and replantation, 2 cases of postoperative death, 1 case of tumor recurrence, osteotomy nonunion in 1 case, more than 5 cases healed; tumor resection In 2 cases of allogeneic joint healed, 1 case healed and 1 case did not heal. Of the 4 cases of prophylactic internal fixation, 1 died within 1 year after operation and the other 3 cases had good postoperative function. Conclusion Interlocking intramedullary nailing has the advantages of easy positioning, reliable fixation and early functional training in the treatment of pathological fracture, autologous bone inactivation and allograft reconstruction. The preventive internal fixation of bone metastases can be effectively avoided Pathological fracture occurred.