發(fā)布時(shí)間：2018-11-15 19:54

【摘要】：目的探討Orthofix單邊外固定架在骨腫瘤外科治療中的應(yīng)用特點(diǎn)及初步臨床效果。方法回顧分析2011年6月—2016年3月因原發(fā)良、惡性骨腫瘤接受外科治療并應(yīng)用Orthofix單邊外固定架的22例患者臨床資料。男11例,女11例;年齡4~57歲,中位年齡23.5歲。腫瘤切除后骨缺損或肢體短縮部位:股骨上段6例,股骨下段8例,股骨中段3例,脛骨上段2例,脛骨中段3例。外固定架應(yīng)用情況:骨缺損重建后臨時(shí)固定10例(骨缺損長(zhǎng)度6~19 cm,平均12.3 cm;采用帶血管蒂腓骨移植2例,同種異體骨+游離腓骨移植2例,同種異體骨+自體骨移植5例,同種異體骨重建1例);肢體短縮行骨延長(zhǎng)5例(短縮長(zhǎng)度6.5~8.5 cm,平均7.5 cm);3例術(shù)前活檢無(wú)法明確診斷,行切開活檢,為預(yù)防病理骨折臨時(shí)采用外固定架固定;腫瘤切除后骨缺損應(yīng)用骨搬運(yùn)1例(骨缺損長(zhǎng)度7.5 cm);病理骨折術(shù)前化療臨時(shí)固定1例;股骨遠(yuǎn)端骨肉瘤行海扶刀治療后,膝關(guān)節(jié)嚴(yán)重屈曲畸形伴關(guān)節(jié)脫位矯形2例。結(jié)果 22例患者均獲隨訪,隨訪時(shí)間12~72個(gè)月,平均36個(gè)月。10例骨缺損重建患者帶架時(shí)間3~8個(gè)月,平均4.8個(gè)月;均獲滿意骨愈合,愈合時(shí)間3~16個(gè)月,平均6.4個(gè)月;末次隨訪時(shí)國(guó)際保肢學(xué)會(huì)功能評(píng)分93版(MSTS 93)評(píng)分為73.3~93.3分,平均87.2分;患者佩戴外固定架期間未出現(xiàn)并發(fā)癥。5例骨延長(zhǎng)患者帶架時(shí)間7~15個(gè)月;2例延長(zhǎng)過(guò)程中出現(xiàn)成角畸形,2例拆架后出現(xiàn)青枝骨折,CheckettsOtterburn外固定架釘?shù)栏腥痉旨?jí)為輕度感染1級(jí)2例,2級(jí)1例;MSTS 93評(píng)分為80.0~96.7分,平均89.2分。其余患者均無(wú)相關(guān)并發(fā)癥發(fā)生,膝關(guān)節(jié)及踝關(guān)節(jié)活動(dòng)正常。結(jié)論 Orthofix單邊外固定架可用于骨腫瘤切除后復(fù)雜缺損的固定,并可通過(guò)骨延長(zhǎng)糾正兒童保肢術(shù)后肢體不等長(zhǎng)問(wèn)題。
[Abstract]:Objective to investigate the application and clinical effect of Orthofix unilateral external fixator in the surgical treatment of bone tumor. Methods from June 2011 to March 2016, 22 patients with benign and malignant bone tumors received surgical treatment and were treated with Orthofix unilateral external fixator. There were 11 males and 11 females, aged 457 years with a median age of 23.5 years. There were 6 cases of upper femur, 8 cases of lower femur, 3 cases of middle femur, 2 cases of upper tibia and 3 cases of middle tibia after resection of tumor. Application of external fixator: temporary fixation after bone defect reconstruction in 10 cases (bone defect length 619 cm, mean 12.3 cm;) Vascularized fibula transplantation was performed in 2 cases, free fibula allograft in 2 cases, autogenous bone transplantation in 5 cases and allograft bone reconstruction in 1 case. Bone lengthening was performed in 5 cases (6.5 cm, 8.5 cm, mean 7.5 cm);). The biopsy was performed in 3 cases without definite diagnosis, and external fixator was used to prevent pathological fracture. Bone defect was treated with bone transport in 1 case (bone defect length 7.5 cm);) and osteosarcoma of distal femur treated with Heft knife in 1 case, severe flexion deformity of the knee with dislocation of joint was performed in 2 cases. Results all the 22 patients were followed up for 12 ~ 72 months (mean 36 months), 10 patients with bone defect reconstruction had a time of 3 ~ 8 months (mean 4.8 months), all of them were satisfied with bone healing, the healing time was 3 ~ 16 months (mean 6.4 months). At the last follow-up, the score of MSTS 93 was 73.3 ~ 93.3, with an average of 87.2, and there was no complication during the period of external fixation. Angle deformities were found in 2 cases, green branch fractures were found in 2 cases after removal of frame, infection grade of CheckettsOtterburn external fixator was mild infection in 2 cases, grade 2 was grade 2, and MSTS 93 score was 80.096.7 points with an average of 89.2 points. The other patients had no related complications and normal knee and ankle joint activity. Conclusion Orthofix unilateral external fixator can be used to fix complex defects after bone tumor resection, and to correct limb unequal length after limb salvage in children by bone lengthening.
【作者單位】： 北京大學(xué)人民醫(yī)院骨與軟組織腫瘤治療中心骨與軟組織腫瘤研究北京市重點(diǎn)實(shí)驗(yàn)室;
【分類號(hào)】：R738

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