本文關鍵詞：同種異體骨單髁置換治療膝關節(jié)周圍骨腫瘤的長期評價　出處：《山東大學》2015年碩士論文　論文類型：學位論文

  更多相關文章： 骨腫瘤 單髁置換 同種異體骨

【摘要】：膝關節(jié)主要由股骨下端、脛骨上端及髕骨組成,其中前兩者為骨腫瘤好發(fā)部位,例如良性的具有侵襲特性的骨巨細胞瘤,惡性的骨肉瘤、惡性纖維組織細胞瘤等。手術治療是現(xiàn)階段的主要治療措施,但其會造成切除部位骨質缺損,從而影響膝關節(jié)相應功能。對于僅發(fā)生在內髁或外髁處的腫瘤,由于其切除后會嚴重影響膝關節(jié)的功能及穩(wěn)定性,因此關節(jié)重建勢在必行�，F(xiàn)階段主要手術方式包括異體骨移植(包括單髁和半關節(jié)移植),自體骨移植,人工關節(jié)置換重建,異體骨+人工關節(jié)復合移植。其中人工關節(jié)置換重建具有即刻穩(wěn)定,早期活動等優(yōu)點,但具有手術創(chuàng)傷較大,生物力學改變,后期翻修、感染、松動等缺陷；半關節(jié)移植雖可保留相應韌帶軟骨,維持關節(jié)穩(wěn)定,但卻犧牲了對側無腫瘤侵襲的健康單髁,增加了后期關節(jié)磨損的風險；而自體骨移植雖無排異反應,但卻明顯影響關節(jié)的功能。而同種異體骨單髁置換,既保留了骨量,不影響對側半關節(jié),極大程度的保留原膝關節(jié)原有功能,后期如有必要仍可行人工關節(jié)重建。因此,對發(fā)生于膝關節(jié)周圍局限于單髁的腫瘤,特別是像骨巨細胞瘤一類的良性侵襲性腫瘤,同種異體骨單髁置換可能為更加合理的選擇。目的：探討同種異體骨單髁置換,對發(fā)生于股骨下段或脛骨上段,局限于單髁的骨腫瘤的術后功能及影像學評價�？偨Y手術后常見并發(fā)癥及相應注意事項。方法：選自1991.1至2014.10期間,我院收治的發(fā)生于股骨下段及脛骨上段單側髁的骨腫瘤11例,術前影像學檢查確認,腫瘤侵及范圍未超過髁部橫斷面的1/2,未突破關節(jié)面,未侵犯血管神經(jīng)束,局部軟組織情況良好。男8例,女3例。其中骨巨細胞瘤8例,惡性纖維組織細胞瘤2例,良性纖維組織細胞瘤1例。其中骨巨細胞瘤Campanacci分級Ⅱ級6例,Ⅲ級2例,惡性骨腫瘤均為IIA期。股骨外側髁7例,股骨內側髁2例,脛骨內側髁2例。手術時平均年齡35.3歲(22～46歲),1例骨巨細胞瘤為刮除植骨復發(fā)再次手術,其余10例均為初次手術。所有患者術前均經(jīng)X線、CT及MRI確定病變范圍及術中切除瘤段骨范圍,術前準備體積形態(tài)合適同種異體骨單髁備用。對于良性腫瘤行邊緣切除,惡性腫瘤行廣泛切除。應用Musculoskeletal Tumor Society (MSTS)下肢功能評分系統(tǒng)及the International Society of Limb Salvage (ISOLS)影像學評分系統(tǒng),對患者術后下肢功能及移植骨影像學評分,系統(tǒng)的評價同種異體骨單髁置換的預后長期評價。結果：所有11例手術均按照預期完成。術后隨訪平均時間148.6月(9～288月)。患者1例惡性纖維組織細胞瘤患者,術后5年因肺轉移去世；1例骨巨細胞瘤患者,術后2年局部復發(fā),行膝關節(jié)假體置換,術后無瘤生存；其余9例患者均長期無瘤生存。現(xiàn)繼續(xù)使用異體骨單髁置換9名。其中1例因螺釘斷裂取出,1例主動要求鋼板取出。4例患者出現(xiàn)較明顯的關節(jié)退變表現(xiàn),1例出現(xiàn)骨不連,6例出現(xiàn)骨質吸收。MSTS下肢功能評分為25.6分(17～30分),ISOLS影像學評分為85.5%(69.4%～97.2%)。結論：對于膝關節(jié)周圍局限于單髁的腫瘤而言,面對腫瘤切除后的骨缺損,行同種異體骨單髁置換術,可較好的維持膝關節(jié)原有功能,降低復發(fā)率,保持骨的生物學完整性,是一種切實可靠的手術方法。
[Abstract]:The knee joint is mainly composed of femur, tibia and patella, the former two bone tumor sites such as benign invasive characteristics of giant cell tumor, malignant osteosarcoma, malignant fibrous histiocytoma. Surgical treatment is the main treatment measures at this stage of the application, but it will cause the resection of bone defect. Which affect the knee joint function. The corresponding only, condylar or lateral condyle tumor because of its resection will seriously affect the stability and function of the knee joint, the joint reconstruction is imperative. The main operation modes of this stage include bone allograft (including single condyle and osteoarticular allograft), autogenous bone graft, artificial joint replacement reconstruction of bone allograft and artificial joint graft. The artificial joint replacement reconstruction has the advantages of immediate stability, early activity, but has a larger surgical trauma, the change of biological resources, late revision , infection, loosening and other defects; semi joint transfer can retain the corresponding ligament cartilage, maintaining joint stability, but at the expense of the non tumor invasion of the contralateral healthy unicompartment, increased the risk of late joint wear; and autogenous bone graft without rejection, but the joint function has significant effect. The allograft bone unicompartment arthroplasty, retain bone mass, does not affect the contralateral half joint, knee joint greatly to retain the original original function, later if necessary is feasible for artificial joint reconstruction. Therefore, occurs around the knee confined to single condyle tumor, especially as benign tumor invasion of giant cell tumor of bone of a class, allograft bone unicompartment arthroplasty may be more reasonable choice. Objective: To investigate the effect of allogeneic bone unicompartment arthroplasty, to occur in the distal femur or proximal tibia, bone tumor confined to single condyle postoperative function and imaging evaluation. Summarize the hand The common complications and corresponding precautions after operation. Methods: from 1991.1 to 2014.10 during the occurrence of bone tumor in our hospital in the distal femur and proximal tibia unilateral condyle in 11 cases, preoperative imaging examination confirmed that tumor invasion and the range does not exceed the condylar cross-sectional 1/2, without breaking the articular surface, without vascular invasion the nerve bundle, local soft tissue condition. 8 cases were male, 3 were female. Of which 8 cases of giant cell tumor of bone, 2 cases of malignant fibrous histiocytoma, 1 cases of benign fibrous histiocytoma. Of which 6 cases of giant cell tumor of bone Campanacci grade II, 2 cases of grade III malignant bone tumor were IIA period. The lateral femoral condyle in 7 cases, 2 cases of medial condyle of femur, 2 cases of medial condyle of tibia. The operation with an average age of 35.3 years (22 ~ 46), 1 cases of giant cell tumor of bone for curettage and bone grafting surgery recurrence, the remaining 10 cases were primary surgery. All patients underwent X-ray, CT and MRI to determine the disease the scope and operation Resection of tumor segment bone, preoperative preparation form suitable volume of allogeneic bone unicompartment for standby. Benign tumors resection margins and malignant tumor resection. The application of Musculoskeletal Tumor Society (MSTS) of lower extremity function score system and the International Society of Limb Salvage (ISOLS) imaging scoring system for postoperative lower limb function and the bone imaging score, prognosis evaluation of allogenic bone unicompartment arthroplasty system long-term evaluation. Results: all 11 cases were expected to be completed in accordance with the time. The average postoperative follow-up period was 148.6 months (9 to 288 months). 1 patients with malignant fibrous histiocytoma, 5 years after surgery for lung metastasis died; 1 cases of giant cell tumor of bone in patients with local recurrence 2 years after surgery, knee joint prosthesis replacement, disease-free survival after surgery; the remaining 9 patients had long-term disease-free survival. We continue to use allogeneic bone unicompartmental replacement 9. 1 cases were removed by screw fracture, 1 cases of active.4 patients had required the removal of steel plate joint degeneration is more obvious, 1 cases of nonunion, 6 cases of lower limb bone resorption function.MSTS score was 25.6 points (17 to 30), ISOLS imaging score was 85.5% (69.4% ~ 97.2%) on. For around the knee confined to single condyle tumor, with bone defect after tumor resection, underwent allogeneic bone unicompartmental arthroplasty, can better maintain the original function of the knee joint, reduce the recurrence rate, keep the integrity of bone biology, is a practical and reliable operation.

【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R738.1

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