發(fā)布時間：2018-10-04 21:12

【摘要】：目的： 探討腓骨小頭切除對脛骨上段腫瘤保肢治療人工關(guān)節(jié)重建術(shù)的影響。方法： 1999年7月-2013年3月,76例脛骨上段骨腫瘤患者行保肢術(shù)。術(shù)中行瘤段切除、人工全膝關(guān)節(jié)重建,腓腸肌內(nèi)側(cè)頭肌瓣敷蓋,其中38例同時行腓骨小頭切除(A組),38例保留腓骨小頭(B組)。兩組患者性別、年齡、側(cè)別、腫瘤類型及分期、病程比較,差異無統(tǒng)計學(xué)差異,具有可比性。觀察比較兩組術(shù)后相關(guān)并發(fā)癥發(fā)生情況,X線片觀察假體位置,采用1993年美國骨腫瘤學(xué)會評分系統(tǒng)(MSTS93)評分系統(tǒng)評定關(guān)節(jié)功能。結(jié)果： 患者均獲隨訪,隨訪時間12-150個月,平均87個月。術(shù)后A組1例(2.63%)發(fā)生皮下軟組織層感染,顯著低于B組6例(15.79%)(χ2=3.934,P=0.047)。A組1例(2.63%)、B組2例(5.26%)發(fā)生腓腸肌內(nèi)側(cè)頭壞死。X線片復(fù)查示A組4例(10.53%)、B組6例(15.79%)發(fā)生假體松動。A組2例(5.26%)、B組4例(10.53%)存在膝關(guān)節(jié)不穩(wěn)。A組3例(7.89%)、B組5例(13.16%)腫瘤局部復(fù)發(fā),A組7例(18.42%)、B組6例(15.79%)發(fā)生遠處轉(zhuǎn)移,A組8例(21.05%)、B組7例(18.42%)死亡。術(shù)后6個月,根據(jù)MSTS93評分系統(tǒng),A組獲優(yōu)23例,良10例,中3例,差2例,優(yōu)良率為86.84%；B組獲優(yōu)21例,良11例,中3例,差3例,優(yōu)良率為84.21%。兩組優(yōu)良率比較,差異無統(tǒng)計學(xué)意義(χ2=0.106,P=0.744)。結(jié)論： 脛骨上段腫瘤行保肢手術(shù)人工關(guān)節(jié)重建同時行腓骨小頭切除術(shù)利于術(shù)中軟組織覆蓋,可減少植皮術(shù)創(chuàng)傷及相應(yīng)并發(fā)癥,降低術(shù)后感染率,術(shù)后關(guān)節(jié)穩(wěn)定性、關(guān)節(jié)活動度良好。
[Abstract]:Objective: to investigate the effect of fibula microcephalectomy on prosthetic joint reconstruction for upper tibial tumor. Methods: from July 1999 to March 2013, 76 patients with upper tibial bone tumor underwent limb salvage. Resection of tumor segment, reconstruction of total knee joint, flap of medial gastrocnemius muscle were performed in 38 cases (group A) and preservation of small head of fibula in 38 cases (group B). There were no significant differences in sex, age, side, tumor type and stage, and course of disease between the two groups. The postoperative complications were observed and compared between the two groups. The location of prosthesis was observed by X-ray film. The articular function was evaluated by the American Society of Bone Oncology scoring system (MSTS93) in 1993. Results: all patients were followed up for 12-150 months (mean 87 months). One case (2.63%) developed subcutaneous soft tissue infection in group A after operation. It was significantly lower than that in group B (6 cases (15.79%). Group A (2.63%) and group B (2 cases (5.26%) had medial gastrocnemius head necrosis. X-ray examination showed 4 cases (10.53%) in group A, 6 cases (15.79%) in group B, 6 cases (15.79%) in group B, 2 cases (5.26%) in group B, 4 cases (10.53%) in group B and 3 cases (7.89%) in group B. 5 cases (13.16%) had local recurrence in group A (18.42%), 6 cases (15.79%) in group B had distant metastasis, 8 cases (21.05%) in group A and 7 cases (18.42%) in group B. Six months after operation, according to the MSTS93 scoring system, 23 cases were excellent, 10 cases were good, 3 cases were fair, 2 cases were poor, the excellent and good rate was 86.844B group (21 cases), good (11 cases), moderate (3 cases), poor (3 cases), and excellent and good rate (84.21%). There was no significant difference in the excellent and good rates between the two groups (蠂 ~ 2 = 0.106). Conclusion: artificial joint reconstruction and fibula microcephalectomy for upper tibial tumors are beneficial to soft tissue coverage during operation, which can reduce skin grafting trauma and related complications, reduce postoperative infection rate and postoperative joint stability. The motion of the joint is good.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R738.1

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