【摘要】 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。更多还原

【Abstract】 Objective To evaluate the application of intramedullary interlocking nail in the functional restoration after bone tumor resection.Methods A total of 29 patitents(14 men and 15 women) were involved.Their mean age was 35.5,ranged from 21 to 73.Four patients sustained pathological fracture caused by bone cyst;1 sustained pathological fracture caused by bone-fibrous dysplasia;1 sustained pathological fracture caused by non-ossifying fibroma;8 sustained pathological fracture caused by hone metastases;4 did not sustain pathological fracture caused by hone metastases;and 11 sustained osteosarcoma.The lesion was at the humerus(n=3),the tibia(n=2),and the femur(n=24).Fourteen patients underwent open reduction and intramedullary interlocking nail fixation;9 underwent tumor segmental resection and inactivation followed by intramedullary interlocking nail fixation;2 underwent tumor segmental resection and hemi-articular allograft transplantation followed by intramedullary interlocking nail fixation; and 4 underwent preventive intramedullary interlocking nail fixation.Results After the follow-up of 12 to 48 months, among the 14 patients who underwent open reduction,8 sustained bone metastases,5 died and 1 sustained expanded tumor range.Two of the other patients almost regained function.No relapse occurred in the 6 patients who had benign tumor,and their fractures all healed.One of the 2 patients who underwent tumor segmental resection and hemi-articular allograft transplantation followed by intramedullary interlocking nail fixation recovered,and the other did not.Among the 4 patients who underwent preventive intramedullary interlocking nail fixation,1 died within 1 year after surgery, but the other 3 regained good function.Conclusions In treating pathological fracture,devitalized bone replantation and allograft transplantation,intramedullary interlocking nail has the following advantages:easy contraposition,stable fixation,and early exercise.The bone metastases preventive internal fixation can avoid the occurrence of pathological fracture.更多还原