中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2015年
2期
127-132
,共6页
杨强%王鲁强%杨志平%李昕%李振峰%李建民
楊彊%王魯彊%楊誌平%李昕%李振峰%李建民
양강%왕로강%양지평%리흔%리진봉%리건민
股骨肿瘤%四肢%挽救疗法%假体失效%再手术
股骨腫瘤%四肢%輓救療法%假體失效%再手術
고골종류%사지%만구요법%가체실효%재수술
Femoral neoplasms%Extremities%Salvage therapy%Prosthesis failure%Reoperation
目的 介绍定制肿瘤型关节假体髓外柄断裂的有限翻修方法,并评价其临床应用效果.方法 3例患者行定制肿瘤型关节假体置换术后发生假体髓外柄断裂,男2例,女1例;年龄分别为25岁、51岁和52岁.原发肿瘤部位及病理组织学类型分别为股骨远端骨肉瘤、股骨远端复发性骨巨细胞瘤及股骨近端软骨肉瘤.假体髓外柄断裂分别发生于术后11个月、34个月和28个月,均无明显外伤史,为行走时发生假体断裂.假体断裂处位于股骨远端假体髓外柄结合部和股骨近端假体的股骨颈基底部.依据假体断裂后髓内柄固定牢固及髓外柄残留足够长度的情况,为避免常规翻修手术中较困难的原假体髓内柄及骨水泥取出,设计了股骨近端和远端翻修假体进行有限翻修,该翻修假体由套筒部和关节部组成,材质及关节部外形与原假体相同,翻修时保留原假体髓内柄,将翻修假体套接于残留的髓外柄,骨水泥及挤压螺钉固定,同时更换磨损的配件,从而完成有限翻修.术后常规功能锻炼,定期随访观察翻修假体稳定性及肢体功能恢复情况.结果 3例患者假体断裂原因为股骨远端假体髓外柄结合部、股骨近端假体股骨颈基底部疲劳断裂各1例,股骨远端假体髓外柄结合部松动、锁钉断裂1例.翻修术后分别随访1个月、103个月和110个月,1例骨巨细胞瘤患者发生软组织内肿瘤复发而再行肿瘤切除术.至末次随访时,3例患者翻修假体固定牢固、无松动.MSTS评分肢体功能评分分别为66.7％、86.7％和83.3％.结论 定制肿瘤型关节假体由于疲劳或结构失效可发生断裂,套接式翻修假体可保留固定牢固的原假体髓内柄而行有限翻修,降低了手术难度,有利于肢体功能的尽快恢复.
目的 介紹定製腫瘤型關節假體髓外柄斷裂的有限翻脩方法,併評價其臨床應用效果.方法 3例患者行定製腫瘤型關節假體置換術後髮生假體髓外柄斷裂,男2例,女1例;年齡分彆為25歲、51歲和52歲.原髮腫瘤部位及病理組織學類型分彆為股骨遠耑骨肉瘤、股骨遠耑複髮性骨巨細胞瘤及股骨近耑軟骨肉瘤.假體髓外柄斷裂分彆髮生于術後11箇月、34箇月和28箇月,均無明顯外傷史,為行走時髮生假體斷裂.假體斷裂處位于股骨遠耑假體髓外柄結閤部和股骨近耑假體的股骨頸基底部.依據假體斷裂後髓內柄固定牢固及髓外柄殘留足夠長度的情況,為避免常規翻脩手術中較睏難的原假體髓內柄及骨水泥取齣,設計瞭股骨近耑和遠耑翻脩假體進行有限翻脩,該翻脩假體由套筒部和關節部組成,材質及關節部外形與原假體相同,翻脩時保留原假體髓內柄,將翻脩假體套接于殘留的髓外柄,骨水泥及擠壓螺釘固定,同時更換磨損的配件,從而完成有限翻脩.術後常規功能鍛煉,定期隨訪觀察翻脩假體穩定性及肢體功能恢複情況.結果 3例患者假體斷裂原因為股骨遠耑假體髓外柄結閤部、股骨近耑假體股骨頸基底部疲勞斷裂各1例,股骨遠耑假體髓外柄結閤部鬆動、鎖釘斷裂1例.翻脩術後分彆隨訪1箇月、103箇月和110箇月,1例骨巨細胞瘤患者髮生軟組織內腫瘤複髮而再行腫瘤切除術.至末次隨訪時,3例患者翻脩假體固定牢固、無鬆動.MSTS評分肢體功能評分分彆為66.7％、86.7％和83.3％.結論 定製腫瘤型關節假體由于疲勞或結構失效可髮生斷裂,套接式翻脩假體可保留固定牢固的原假體髓內柄而行有限翻脩,降低瞭手術難度,有利于肢體功能的儘快恢複.
목적 개소정제종류형관절가체수외병단렬적유한번수방법,병평개기림상응용효과.방법 3례환자행정제종류형관절가체치환술후발생가체수외병단렬,남2례,녀1례;년령분별위25세、51세화52세.원발종류부위급병리조직학류형분별위고골원단골육류、고골원단복발성골거세포류급고골근단연골육류.가체수외병단렬분별발생우술후11개월、34개월화28개월,균무명현외상사,위행주시발생가체단렬.가체단렬처위우고골원단가체수외병결합부화고골근단가체적고골경기저부.의거가체단렬후수내병고정뢰고급수외병잔류족구장도적정황,위피면상규번수수술중교곤난적원가체수내병급골수니취출,설계료고골근단화원단번수가체진행유한번수,해번수가체유투통부화관절부조성,재질급관절부외형여원가체상동,번수시보류원가체수내병,장번수가체투접우잔류적수외병,골수니급제압라정고정,동시경환마손적배건,종이완성유한번수.술후상규공능단련,정기수방관찰번수가체은정성급지체공능회복정황.결과 3례환자가체단렬원인위고골원단가체수외병결합부、고골근단가체고골경기저부피로단렬각1례,고골원단가체수외병결합부송동、쇄정단렬1례.번수술후분별수방1개월、103개월화110개월,1례골거세포류환자발생연조직내종류복발이재행종류절제술.지말차수방시,3례환자번수가체고정뢰고、무송동.MSTS평분지체공능평분분별위66.7％、86.7％화83.3％.결론 정제종류형관절가체유우피로혹결구실효가발생단렬,투접식번수가체가보류고정뢰고적원가체수내병이행유한번수,강저료수술난도,유리우지체공능적진쾌회복.
Objective To introduce a new method of limited revision for the extramedullary stem fracture of the custommade tumor prostheses and evaluate its clinical effect.Methods There were 3 patients with extramedullary stem fracture after custom-made tumor prostheses replacement,2 male and 1 female.The age was 25,51 and 52 years old respectively.The pathological diagnosis and involved locations were osteosarcoma of distal femur,recurrent giant cell tumor of distal femur,and chondrosarcoma of proximal femur.The interval between replacement operation and extramedullary stem fracture were 11 months,34 months and 28 months respectively.The fracture occurred when they were walking without obvious history of trauma.The fracture sites located at the conjunction of the extramedullary stems in distal femoral prostheses and femoral neck basis in proximal femoral prosthesis.According to the firm fixation of the intramedullary stem and the enough length of the residual extramedullary stem,the revision prosthesis for limited revision operation was designed in order to avoid removing the firmly fixed intramedullary stem and bone cement which is very difficult.The revision prosthesis consists of sleeve part and joint part with the same material as former prosthesis,which is sleeved to the residual extramedullary stem and fixed by bone cement and interference screws in limited revision operation.The wearing fittings were replaced at the same time.Patients took regularly functional exercises postoperatively.The stability of revision prosthesis and the function of the involved limbs were observed in follow-up.Results The reasons of prosthesis fracture were fatigue fractures at the conjunction of extramedullary stem in one distal femur prosthesis,at the basis of femoral neck in one proximal femur prosthesis and conjunction loosening and locked screw breakage in the other distal femur prosthesis.The follow-up times were 1 month,103 months and 1 10 months respectively.One patient with giant cell tumor underwent tumor resection due to tumor recurrence in soft tissue.The revision prostheses were fixed firmly without loosening.According the MSTS scoring system,the scores of involved extremities function were 66.7％、86.7％ and 83.3％ respectively.Conclusion The fracture of custom-made tumor prosthesis could occur due to metal fatigue and conjunction failure.The newly designed revision prosthesis allows a limited revision operation with preserving the firmly fixed intramedullary stem,which reduces the difficulty of operation and makes the recovery of the limb function as soon as possible.
