【摘要】 目的对比生物型与水泥型组配式旋转铰链假体重建股骨远端普通型骨肉瘤切除后骨缺损的临床疗效,为临床应用提供参考。方法回顾分析 2011 年 10 月至 2018 年 9 月,本中心使用生物型假体及水泥型假体系统治疗股骨远端普通型骨肉瘤的共 157 例资料,生物型假体组均使用 Megasystem-C 假体系统,水泥型假体组均使用力达康假体系统。其中生物型假体组 66 例,水泥型假体组 91 例。记录两组患者性别、年龄、出血量、手术时间、截骨长度及生存情况。记录并对比两组假体存留情况、并发症 (根据 Henderson 定义的分型方式分为 5 型) 发生情况及假体失败后的治疗措施。根据 MSTS93 评分系统比较末次随访时两组患者下肢功能评分。使用 Kaplan-Meier 生存分析及 Log-rank 检验分析比较两组患者的生存率与假体存留率。结果本组 157 例术后均获 5～106 个月随访,平均 44 个月。生物固定组中位随访 39 个月,患者 3、5 年生存率分别为 83.5%、67.1%,假体 3、5 年存留率分别为 91.2%、84.2%。并发症包括软组织失败 3 例,无菌性松动1 例,机械性失败 1 例,假体感染 2 例,肿瘤复发 3 例。术后 MSTS93 功能评分 (25±2) 分。水泥固定组中位随访 45 个月,患者 3、5 年生存率分别为 77.0%、68.1%,假体 3、5 年存留率分别为 91.6%、84.9%。并发症包括软组织失败 3 例,无菌性松动 10 例,机械性失败 2 例,假体感染 3 例,肿瘤复发 4 例。术后 MSTS93 功能评分 (24±2) 分。两组患者的生存率、假体存留率及术后功能差异无统计学意义。两组无菌性松动发生率,差异有统计学意义 (P=0.048),其余各型并发症发生率对于两组假体重建差异无统计学意义。结论两类假体重建股骨远端肿瘤切除后骨缺损,二者具有相似的患者生存率、假体存留率、患肢功能,生物固定假体组较水泥固定假体组无菌性松动发生率更低。更多还原

【Abstract】 Objective To report the clinical comparative results between uncemented and cemented endoprosthetic replacements for conventional distal femoral osteosarcoma resection.Methods We retrospective reviewed the charts of 157 patients who received conventional distal femoral osteosarcoma resection and endoprosthetic reconstruction from October 2011 to September 2018.We exclusively used 66 uncemented Megasystem-C modular prostheses and 91 cemented Lidakang modular prostheses for distal femoral tumor reconstructions.Gender,age,intraoperative blood loss,operating time,length of bone resection and survival of patients of the two groups were recorded.Outcomes of endoprosthetic survival,complications were categorized according to the Henderson Failure Mode Classification and limb function scores were evaluated.Survival of patients and prostheses were calculated using Kaplan-Meier analysis.Results All patients were followed up for 5-106 months with a median of 44 months.The 3-year and 5-year survival rates were 83.5%,67.1% for patients of uncemented group and 77.0%,68.1% for patients of cemented group.The 3-year and 5-year prosthetic survival rates were 91.2%,84.2% for uncemented group and 91.6%,84.9% for cemented group respectively.There were no significant differences in prosthetic survival rate between the two groups.There were 3 cases of type 1 failure,1 case of type 2 failure,1 case of type 3 failure,2 cases of type 4 failure,3 cases of type 5 failure for uncementd group and 3 cases of type 1 failure,10 cases of type 2 failure,2 cases of type 3 failure,3 cases of type 4 failure,4 cases of type 5 failure for uncementd group.The MSTS scores were (25±2) and (24±2) for the two groups without significant differences.The aseptic loosening rate was lower for uncemented group than cemented group (P=0.048) and there were no significant differences for the other4 types of complication between the two groups.Conclusions Reconstruction with uncemented or cemented prosthesis achieves equal patient survival,prosthetic survival and limb function.Uncemented prostheses will provide lower aseptic loosening rate than cemented prostheses.更多还原