中国组织工程研究与临床康复
中國組織工程研究與臨床康複
중국조직공정연구여림상강복
JOURNAL OF CLINICAL REHABILITATIVE TISSUE ENGINEERING RESEARCH
2009年
48期
9418-9422
,共5页
膝关节%肿瘤%假体%置换
膝關節%腫瘤%假體%置換
슬관절%종류%가체%치환
背景:随着新化疗方案的成熟,骨肿瘤5年生存率明显升高,膝关节肿瘤保肢手术已替代截肢术,成为主要的治疗手段并取得了良好的效果.目的:比较膝关节肿瘤保肢手术采用单纯铰链型与旋转铰链型假体置换的临床效果.设计、时间及地点:对比观察,病例来自1999-06/2006-03广西医科大学第一附属医院骨病科.对象:选择广西医科大学第一附属医院骨病科收治的膝关节骨肿瘤患者72例,排除失访9例,余63例中男35例,女28例,年龄15~58岁,平均31岁.其中采用单纯铰链型假体置换40例,采用旋转铰链型假体置换23例.方法:胫骨上端肿瘤瘤段切除假体置换根据Ennecking外科手术切除原则,按最佳边界切除肿瘤.单纯铰链式假体铰链关节复位后置螺栓,调整关节松紧度后锁定;可旋转式放置高分子聚乙烯衬垫,安装关节旋转轴.股骨下端肿瘤瘤段切除假体置换切口起自大腿内侧沿股内侧肌后缘下行,止于胫骨上端髌韧带内侧,按最佳边界切除肿瘤.单纯铰链式假体铰链关节复位后置螺栓,调整关节松紧度后锁定;可旋转式放置高分子聚乙烯衬垫,安装关节旋转轴.主要观察指标:按MSTS膝关节评分标准、ambulation scores、关节屈伸度及感染、复发、置换时间评估两组患者的疗效.结果:63例患者随访时间9个月~8年.①单纯铰链型假体置换组:置换时间(2.663±0.336)h,复发5例,转移死亡3例,感染2例.旋转铰链型假体置换组:置换时间(2.572±0.288)h,复发3例,转移死亡2例,感染2例.旋转铰链型假体置换组1例置换后发生旋转轴聚乙烯轴套断裂关节脱位,再次手术更换轴套后未再出现并发症,两组无假体松动病例.②去除复发及转移病例,余50例进行功能评估,两组MSTS评分差异无显著性意义(P>0.05);ambulation scores各个单项及总分旋转铰链型假体置换组均高于单纯铰链型假体置换组(P<0.05).③两组术后膝关节伸直角度均能达到或接近0°,单纯铰链型假体置换组屈曲度(119.375z±17.490)°,与旋转铰链型假体置换组(125.000±15.340)°相比,差异无显著性意义(P=0.260). 结论:①旋转铰链型假体在置换后功能方面优于单纯铰链型假体.②按ambulation scores标准,膝关节功能方面旋转铰链型假体置换组优于单纯铰链型假体置换组,而MSTS评分未能体现,因此ambulation scores在评价膝关节保肢术后功能方面更敏感和适用.③在置换时间、置换后临床屈伸功能及并发症方面单纯铰链型与旋转铰链型假体无显著性差异.
揹景:隨著新化療方案的成熟,骨腫瘤5年生存率明顯升高,膝關節腫瘤保肢手術已替代截肢術,成為主要的治療手段併取得瞭良好的效果.目的:比較膝關節腫瘤保肢手術採用單純鉸鏈型與鏇轉鉸鏈型假體置換的臨床效果.設計、時間及地點:對比觀察,病例來自1999-06/2006-03廣西醫科大學第一附屬醫院骨病科.對象:選擇廣西醫科大學第一附屬醫院骨病科收治的膝關節骨腫瘤患者72例,排除失訪9例,餘63例中男35例,女28例,年齡15~58歲,平均31歲.其中採用單純鉸鏈型假體置換40例,採用鏇轉鉸鏈型假體置換23例.方法:脛骨上耑腫瘤瘤段切除假體置換根據Ennecking外科手術切除原則,按最佳邊界切除腫瘤.單純鉸鏈式假體鉸鏈關節複位後置螺栓,調整關節鬆緊度後鎖定;可鏇轉式放置高分子聚乙烯襯墊,安裝關節鏇轉軸.股骨下耑腫瘤瘤段切除假體置換切口起自大腿內側沿股內側肌後緣下行,止于脛骨上耑髕韌帶內側,按最佳邊界切除腫瘤.單純鉸鏈式假體鉸鏈關節複位後置螺栓,調整關節鬆緊度後鎖定;可鏇轉式放置高分子聚乙烯襯墊,安裝關節鏇轉軸.主要觀察指標:按MSTS膝關節評分標準、ambulation scores、關節屈伸度及感染、複髮、置換時間評估兩組患者的療效.結果:63例患者隨訪時間9箇月~8年.①單純鉸鏈型假體置換組:置換時間(2.663±0.336)h,複髮5例,轉移死亡3例,感染2例.鏇轉鉸鏈型假體置換組:置換時間(2.572±0.288)h,複髮3例,轉移死亡2例,感染2例.鏇轉鉸鏈型假體置換組1例置換後髮生鏇轉軸聚乙烯軸套斷裂關節脫位,再次手術更換軸套後未再齣現併髮癥,兩組無假體鬆動病例.②去除複髮及轉移病例,餘50例進行功能評估,兩組MSTS評分差異無顯著性意義(P>0.05);ambulation scores各箇單項及總分鏇轉鉸鏈型假體置換組均高于單純鉸鏈型假體置換組(P<0.05).③兩組術後膝關節伸直角度均能達到或接近0°,單純鉸鏈型假體置換組屈麯度(119.375z±17.490)°,與鏇轉鉸鏈型假體置換組(125.000±15.340)°相比,差異無顯著性意義(P=0.260). 結論:①鏇轉鉸鏈型假體在置換後功能方麵優于單純鉸鏈型假體.②按ambulation scores標準,膝關節功能方麵鏇轉鉸鏈型假體置換組優于單純鉸鏈型假體置換組,而MSTS評分未能體現,因此ambulation scores在評價膝關節保肢術後功能方麵更敏感和適用.③在置換時間、置換後臨床屈伸功能及併髮癥方麵單純鉸鏈型與鏇轉鉸鏈型假體無顯著性差異.
배경:수착신화료방안적성숙,골종류5년생존솔명현승고,슬관절종류보지수술이체대절지술,성위주요적치료수단병취득료량호적효과.목적:비교슬관절종류보지수술채용단순교련형여선전교련형가체치환적림상효과.설계、시간급지점:대비관찰,병례래자1999-06/2006-03엄서의과대학제일부속의원골병과.대상:선택엄서의과대학제일부속의원골병과수치적슬관절골종류환자72례,배제실방9례,여63례중남35례,녀28례,년령15~58세,평균31세.기중채용단순교련형가체치환40례,채용선전교련형가체치환23례.방법:경골상단종류류단절제가체치환근거Ennecking외과수술절제원칙,안최가변계절제종류.단순교련식가체교련관절복위후치라전,조정관절송긴도후쇄정;가선전식방치고분자취을희츤점,안장관절선전축.고골하단종류류단절제가체치환절구기자대퇴내측연고내측기후연하행,지우경골상단빈인대내측,안최가변계절제종류.단순교련식가체교련관절복위후치라전,조정관절송긴도후쇄정;가선전식방치고분자취을희츤점,안장관절선전축.주요관찰지표:안MSTS슬관절평분표준、ambulation scores、관절굴신도급감염、복발、치환시간평고량조환자적료효.결과:63례환자수방시간9개월~8년.①단순교련형가체치환조:치환시간(2.663±0.336)h,복발5례,전이사망3례,감염2례.선전교련형가체치환조:치환시간(2.572±0.288)h,복발3례,전이사망2례,감염2례.선전교련형가체치환조1례치환후발생선전축취을희축투단렬관절탈위,재차수술경환축투후미재출현병발증,량조무가체송동병례.②거제복발급전이병례,여50례진행공능평고,량조MSTS평분차이무현저성의의(P>0.05);ambulation scores각개단항급총분선전교련형가체치환조균고우단순교련형가체치환조(P<0.05).③량조술후슬관절신직각도균능체도혹접근0°,단순교련형가체치환조굴곡도(119.375z±17.490)°,여선전교련형가체치환조(125.000±15.340)°상비,차이무현저성의의(P=0.260). 결론:①선전교련형가체재치환후공능방면우우단순교련형가체.②안ambulation scores표준,슬관절공능방면선전교련형가체치환조우우단순교련형가체치환조,이MSTS평분미능체현,인차ambulation scores재평개슬관절보지술후공능방면경민감화괄용.③재치환시간、치환후림상굴신공능급병발증방면단순교련형여선전교련형가체무현저성차이.
BACKGROUND: With the development of n0eo-adjuvant chemotherapy, 5-year survival rate of bone tumors has significantly increased. Limb salvage has replaced amputation to become a major means of treating knee tumors and has achieved good results. OBJECTIVE: To investigate and compare the effect of knee joint reconstruction using hinge-knee system and rotating knee system. DESIGN, TIME AND SETTING: Comparative observation. The patients were selected from Department of Spine and Orthopedic Surgery, First Affiliated Hospital of Gaungxi Medical University between June 1999 and March 2006. PARTICIPANTS: A total of 72 patients with tumor round the knee were selected from the First Affiliated Hospital of Gaungxi Medical University, and 9 cases were lost in follow-up. Of the remaining 63 cases, there were 35 males and 28 females, aged 31 years (range, 15-58 years); 40 cases underwent knee joint reconstruction using hinge-knee system and 23 using rotating knee system. METHODS: The tumor excision of superior tibia was performed according to Ennecking principle. After joint reduction of hinge-knee prosthesis, the bolt was adjusted and locked; the high polymer polyethylene pad was placed in rotating knee system, and the joint rotation axis was assembled. The tumor excision of inferior tibia was performed from the medial thigh along medial vastus muscle posterior margin till medial patellar ligament of superior tibia. After joint reduction of hinge-knee prosthesis, the bolt was adjusted and locked; the high polymer polyethylene pad was placed in rotating knee system, and the joint rotation axis was assembled. MAIN OUTCOME MEASURES: The treatment effect was evaluated according to MSTS functional scores, ambulation scores, flexion-extension-angle, knee rotation and infection, relapse and operative time. RESULTS: The 63 patients were followed up for 9 months to 8 years. In hinge-knee system group, operative time was (2.663±0.336) hours; there were 5 cases of relapse, 3 cases of metastasis/death and 2 case of infection. In rotating knee system group, operative time was (2.572±0.288) hours; there were 3 cases of relapse, 2 cases of metastasis/death, and 2 case of infection. One case in rotating knee system group developed fracture and dislocation of the polyethylene bush of rotating axis and there was no syndrome after changing fittings. No prosthesis loosening was found in two groups. With exception of patients with relapse and metastasis/death, 50 cases were evaluated, and no significant difference was found in MSTS scores between two groups (P > 0.05); the total score and single item score of ambulation scores in rotating knee system group were significantly greater than hinge-knee system group (P < 0.05). The extension angle in two groups reached or was close to 0°, and the flexion-extension angle of hinge-knee system group (119.375±17.490)° was similar to rotating knee system group (125.000±15.340)° (P=0.260). CONCLUSION: The rotating knee system displays superior function than hinge-knee system in knee salvage after surgery. Ambulation scores revealed that the knee joint function of the rotating knee system is superior over hinge-knee system, while the MSTS scores did not. Therefore, ambulation scores is more sensitive and appropriate to evaluate the function after knee salvage. There were no significant differences in operative time and flexion-extension ability and syndrome between two methods.
