中国组织工程研究
中國組織工程研究
중국조직공정연구
Journal of Clinical Rehabilitative Tissue Engineering Research
2014年
26期
4115-4119
,共5页
植入物%人工假体%节植入物%人工全髋关节置换%股骨近端%骨肿瘤%肿瘤转移
植入物%人工假體%節植入物%人工全髖關節置換%股骨近耑%骨腫瘤%腫瘤轉移
식입물%인공가체%절식입물%인공전관관절치환%고골근단%골종류%종류전이
femoral neoplasms%internal fixators%arthroplasty,replacement,hip%neoplasm metastasis
背景：随着医疗水平的提高，肢体恶性肿瘤保肢手术的价值日益提高，目前已替代截肢，成为当今肢体肿瘤外科治疗的主流与发展方向。但目前为止，对股骨近端肿瘤还没有统一的手术适应证，仍存在争议。目的：观察人工全髋关节置换联合瘤段扩大切除治疗股骨近端骨肿瘤的效果。方法：选取中南大学湘雅二医院收治的股骨近端骨肿瘤患者并随机分为对照组和观察组，每组30例。对照组患者根据病情选择病灶刮除，瘤体壁灭活，自体和(或)异体骨、人工骨混合植骨后行植入物内固定治疗。观察组患者接受瘤段扩大切除加人工全髋关节置换治疗。比较两组患者手术时间、术中术后出血量、住院时间及关节功能情况。2年后对患者进行回访，比较两组患者的转移复发率、死亡率以及生活质量。结果与结论：两组患者手术时间及术中出血量间无显著性差异(P>0.05)，但观察组患者住院时间短于对照组，关节功能恢复优良率(83%)高于对照组(53%)，术后2年内转移复发率(7%)和死亡率(3%)均低于对照组(30%，23%)。观察组患者生活质量各项指标均优于对照组，差异有显著性意义(P<0.05)。提示人工全髋关节置换治疗股骨近端骨肿瘤安全有效。
揹景：隨著醫療水平的提高，肢體噁性腫瘤保肢手術的價值日益提高，目前已替代截肢，成為噹今肢體腫瘤外科治療的主流與髮展方嚮。但目前為止，對股骨近耑腫瘤還沒有統一的手術適應證，仍存在爭議。目的：觀察人工全髖關節置換聯閤瘤段擴大切除治療股骨近耑骨腫瘤的效果。方法：選取中南大學湘雅二醫院收治的股骨近耑骨腫瘤患者併隨機分為對照組和觀察組，每組30例。對照組患者根據病情選擇病竈颳除，瘤體壁滅活，自體和(或)異體骨、人工骨混閤植骨後行植入物內固定治療。觀察組患者接受瘤段擴大切除加人工全髖關節置換治療。比較兩組患者手術時間、術中術後齣血量、住院時間及關節功能情況。2年後對患者進行迴訪，比較兩組患者的轉移複髮率、死亡率以及生活質量。結果與結論：兩組患者手術時間及術中齣血量間無顯著性差異(P>0.05)，但觀察組患者住院時間短于對照組，關節功能恢複優良率(83%)高于對照組(53%)，術後2年內轉移複髮率(7%)和死亡率(3%)均低于對照組(30%，23%)。觀察組患者生活質量各項指標均優于對照組，差異有顯著性意義(P<0.05)。提示人工全髖關節置換治療股骨近耑骨腫瘤安全有效。
배경：수착의료수평적제고，지체악성종류보지수술적개치일익제고，목전이체대절지，성위당금지체종류외과치료적주류여발전방향。단목전위지，대고골근단종류환몰유통일적수술괄응증，잉존재쟁의。목적：관찰인공전관관절치환연합류단확대절제치료고골근단골종류적효과。방법：선취중남대학상아이의원수치적고골근단골종류환자병수궤분위대조조화관찰조，매조30례。대조조환자근거병정선택병조괄제，류체벽멸활，자체화(혹)이체골、인공골혼합식골후행식입물내고정치료。관찰조환자접수류단확대절제가인공전관관절치환치료。비교량조환자수술시간、술중술후출혈량、주원시간급관절공능정황。2년후대환자진행회방，비교량조환자적전이복발솔、사망솔이급생활질량。결과여결론：량조환자수술시간급술중출혈량간무현저성차이(P>0.05)，단관찰조환자주원시간단우대조조，관절공능회복우량솔(83%)고우대조조(53%)，술후2년내전이복발솔(7%)화사망솔(3%)균저우대조조(30%，23%)。관찰조환자생활질량각항지표균우우대조조，차이유현저성의의(P<0.05)。제시인공전관관절치환치료고골근단골종류안전유효。
BACKGROUND:With elevated medical levels, limb salvage surgery for limb malignant tumor is valuable day by day. At present, the limb salvage surgery has substituted amputation and becomes mainstream and development direction of present surgical treatment of limb tumors. However, so far, there are no unified surgical indications for proximal femur tumor, which are controversial. OBJECTIVE:To investigate the efficacy of artificial total hip arthroplasty combined with extended resection of tumor sections for proximal femoral bone tumors. METHODS:Patients with proximal femoral bone tumors in the Second Xiangya Hospital of Central South University were selected and divided into control group and observation group, with 30 patients in each group. According to the disease, lesion curettage, aneurysm wal inactivation, autologous and (or) al ogeneic bone, mixed bone graft and bone graft fixation were selected to treat the control group. The observation group patients received extended resection of tumor sections and total hip arthroplasty. The operative time, intraoperative blood loss, hospital stay and joint function of two groups were compared. 2 years later, patients were revisited. Metastasis and recurrence rate, death rate and quality of life of two groups were compared. RESULTS AND CONCLUSION:There was no significant difference in intraoperative blood loss and surgery time between the two groups (P>0.05). However, hospital stay of patients in the observation group was shorter than the control group. The excellent and good rate of recovery of joint function (83%) was higher in the observation group than in the control group (53%). The metastasis and recurrence rate within 2 years after surgery (7%) and death rate (3%) were lower in the observation group than in the control group (30%, 23%). Various indicators of quality of life of patients in the observation group were significantly better than the control group (P<0.05). These results confirmed that artificial total hip arthroplasty in the treatment of proximal femur tumors is safe and effective.
