于秀淳;徐明;许宋锋;苏情;孙玉玺;宋若先;

• 1:济南军区总医院骨病科

摘要(Abstract)：

[目的]分析保留自身关节保肢术治疗膝关节周围骨肉瘤的失败原因,指导临床选择正确的修复肿瘤性骨缺损的方式。[方法]1999年1月~2012年12月,对21例膝关节周围骨肉瘤患者行保留自身关节的保肢手术。男12例,女9例;年龄平均14.05岁(5~24岁)。股骨远端19例,胫骨近端2例。MR分型I型15例(2例为合并病理骨折),II型6例。保留骨骺的瘤段切除灭活再植术7例,保留关节的瘤段切除灭活再植术10例,保留骨骺的瘤段切除异体骨移植术2例(1例为带血管蒂腓骨复合异体骨移植术),保留骨骺的骨骺牵张骨搬运术2例。髓内针14例,钢板5例,外固定架2例。[结果]所有患者均获得随访,平均46.47个月(12~150个月),2例分别于术后12个月和8年复发,死亡7例(12~108个月),14例存活(12~150个月)。骨干连接部位的愈合时间平均为14.4个月(6~36个月),骨骺连接部位的愈合时间平均6.95个月(3~36个月)。螺钉松动1例;骨折8例(1例异体骨吸收),7例行10例次切开复位植骨内固定术,1例次行肢体延长术;另1例患者未治疗。除1例骨折和1例复发未处理之外,12例患者的肢体MSTS评分为15~30分,平均为26.7(88.9%)。[结论]年龄、病变性质、部位、骨破坏程度和内固定方式是导致手术失败的主要因素。在严格遵循手术适应证的前提下,应该根据上述因素选择不同的骨修复重建方式。

关键词(KeyWords)： 骨肉瘤;膝关节;保留自身关节;保肢手术

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 于秀淳;徐明;许宋锋;苏情;孙玉玺;宋若先;

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参考文献(References)：

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