CAJ | 학술논문

目的：报告3例股骨远端肿瘤患者假体置换25年后的翻修病例，总结股骨远端肿瘤型假体因远期松动而再次行假体翻修手术的结果与体会。方法回顾性分析2008年1月至2012年12月，3例因股骨远端肿瘤型假体置换术25年后松动，在本院行假体翻修术患者的临床资料，包括临床症状(膝关节周围疼痛、行走困难等)、影像学表现(X线示假体松动移位及翻修后假体位置)、手术方法及技巧、术后功能恢复等，3例翻修术后随访至少5年。结果3例翻修术后临床症状改善，膝关节周围疼痛缓解，术后X线示关节位置可，随访过程中均未出现假体松动、移位、断裂等并发症，根据1993年美国骨肿瘤学会评分系统(MSTS93)，3例术后功能评分分别为70%、80%及73.3%，术后患者功能恢复良好，同时也未出现肿瘤局部复发及转移。结论肿瘤型假体长期使用，可出现松动、感染及排异等并发症。肿瘤假体远期松动行翻修时，取出松动的假体及骨水泥较容易；初次假体置换术后，假体周围会形成大量瘢痕组织甚至生物假膜，生物假膜切除应尽量彻底；翻修时患者多有软组织缺损，应准备肌瓣转移术。
목적：보고3례고골원단종류환자가체치환25년후적번수병례，총결고골원단종류형가체인원기송동이재차행가체번수수술적결과여체회。방법회고성분석2008년1월지2012년12월，3례인고골원단종류형가체치환술25년후송동，재본원행가체번수술환자적림상자료，포괄림상증상(슬관절주위동통、행주곤난등)、영상학표현(X선시가체송동이위급번수후가체위치)、수술방법급기교、술후공능회복등，3례번수술후수방지소5년。결과3례번수술후림상증상개선，슬관절주위동통완해，술후X선시관절위치가，수방과정중균미출현가체송동、이위、단렬등병발증，근거1993년미국골종류학회평분계통(MSTS93)，3례술후공능평분분별위70%、80%급73.3%，술후환자공능회복량호，동시야미출현종류국부복발급전이。결론종류형가체장기사용，가출현송동、감염급배이등병발증。종류가체원기송동행번수시，취출송동적가체급골수니교용역；초차가체치환술후，가체주위회형성대량반흔조직심지생물가막，생물가막절제응진량철저；번수시환자다유연조직결손，응준비기판전이술。
Objective To report revision surgery in 3 patients with tumors in the distal femur who underwent prosthetic replacement 25 years ago and to summarize the experience of revision surgery because of long-time loosening of the tumor prosthesis in the distal femur. Methods A total of 3 patients underwent prosthetic revision from January 2008 to December 2012, due to loosening in the distal femur after prosthetic replacement 25 years ago. Their clinical data were retrospectively analyzed, including the clinical symptoms ( pain around the knee and walking difficulties ), imaging manifestations ( prosthetic loosening and migration and prosthetic position after revision surgery based on the X-ray ), operation methods and techniques, postoperative functional recovery and so on. All the 3 patients were followed up for at least 5 years. Results The clinical symptoms of the 3 patients were improved after revision surgery, with pain relief around the knee. The postoperative X-ray showed the joint position was good. No complications such as prosthetic loosening, migration or breakage were noticed during the follow-up. According to the Musculoskeletal Tumor Society ( MSTS 1993 ) staging system, their postoperative functional scores were 70%, 80%and 73.3%. The postoperative functional recovery of all the patients was satisfactory and no local tumor recurrence or metastasis was noticed. Conclusions The tumor prosthesis is durable. However, the complications such as loosening, infection or rejection may occur. It is relatively easy to pull out the prosthesis and the bone cement in revision surgery due to long-term loosening of the tumor prosthesis. After primary prosthetic replacement, a lot of scar tissues and even biological pseudomembranes will be formed around the prosthesis. Biological pseudomembranes should be resected as completely as possible. Muscle lfap transplantation should be prepared for the patients with soft tissue defects during the revision.