【摘要】 目的探讨采用肿瘤瘤段切除+定制肿瘤型人工关节置换术在四肢长骨骨巨细胞瘤Campanacci’sⅢ级患者保肢治疗中的临床疗效和不良反应.方法回顾2004年1月至2014年1月之间,云南省肿瘤医院收治的经病理活检确诊的29例四肢大关节部位骨巨细胞瘤患者,采用肿瘤瘤段切除+定制型人工关节置换术保肢治疗.其中男14例,女15例.年龄19~85岁,平均39.66岁.发病部位:肱骨上段6例,股骨上段5例,股骨下段12例,胫骨上段6例.Campanacci’s分级均为Ⅲ级.术中行肿瘤边界外切除受累骨与软组织,距肿瘤边缘3~5cm平面行截骨,安装人工假体,重建关节功能.假体柄和宿主骨界面采用骨水泥固定技术.其中胫骨上段瘤段切除的患者应用腓肠肌内侧头转位修复胫骨上段软组织缺损.术后采用MSTS保肢评分系统对随访患者进行功能评价.结果 29例患者随访时间为1~83月,平均36.62月.其中28例患者手术切口Ι期愈合,1例患者引流管口形成窦道,经行清创术后愈合.患者MSTS功能重建评分为12~27分,平均23.10分;患者肢体功能优16例,良11例,中1例,差1例,优良率为93.10%.所有病例均未发生局部复发,1例于术后2 a内死于肺转移.结论肿瘤瘤段切除+定制型人工关节置换术可作为Campanacci’sⅢ级骨巨细胞瘤患者的保肢治疗方案.术前注意正确选择适应证、个体化设计假体,术中给予坚强固定并注意软组织重建方式,可预防并发症并取得良好的临床疗效.更多还原

【Abstract】 Objective To discuss the clinical effect and adverse reaction of resection of tumor segment and custom tumor type artificial joint replacement in treatment of giant cell of bone tumor of long bones of limbs in Campanacci’ s level III patients. Methods Twenty-nine patients with giant cell tumor of bone in large joints of limbs were diagnosed by objective biopsy and treated by tumor segment resection and custom artificial joint replacement between January in 2004 to January in 2014 at Yunnan Province Cancer Hospital. There were 14 male and 15 female patients,aged from 19 to 85(39.66 on average). The location of tumor in patients was: proximal humerus in 6 cases,the upper segment of femur in 5 cases and the lower segment of femur in 15 cases,the proximal tibia with 6 cases.The Campanacci’ s Level was III. We resected the pathological bone and soft tissue out of the tumor boundary in treatment,and truncated bone on surface at 3 to 5 cm to the edge of tumor,and installed artificial prosthesis for reconstruction of the function of human joint. The prosthesis and the interface of host bone were fxied by bone cement fixed technique. The medial head of gastrocnemius muscle transposition was used to repair the soft tissue of proximal tibial of patients underwent the poximal tibial tumor resection. MSTS limb salvage scoring system was used to evaluate the function of patients after treatment. Results The followed up time was 1 to 83 months(36.62 months on average)in 29 patients. I period healing of the operation incision was in 28 patients had, and sinus was formed at the tip of the drainage tube was found in one patient, and the wound were healed after Debridement. The MSTS score in patients was 12 to 27, 23.10 on average. The limb function were excellent in 16 patients,good in 11 patients,moderate in 1 patient and poor in 1 patient,the rate of excellent-good is 93.10%. All cases had no local recurrence,but one was died of lung cancer with metastasis after 2 years.Conclusions The resection of tumor segment and custom artificial joint replacement can be used as limb salvage treatment for giant cell tumor of bone in Campanacci’s level III patients. The correct selection of indication, designing individualized prosthesis, good intraoperative fixation and appropriate soft tissue reconstruction can prevent complications and achieve good clinical efficacy.更多还原