骨肿瘤论文：定制肿瘤型假体置换术后假体生存及并发症的发生和原因分析

1、.骨肿瘤论文：定制肿瘤型假体置换术后假体生存及并发症的发生和原因分析【中文摘要】回顾性研究定制肿瘤型假体置换术后假体生存及与假体及手术相关的并发症的发生,并对其产生原因进行初步分析,讨论手术期间需注意的问题。资料与方法：对1996年4月-2007年4月完成的126例定制肿瘤型假体置换术后患者进行随访,时间3-124个月,平均51个月。男78例,女48例,年龄11-72(33.7±16.5)岁。肿瘤类型：骨肉瘤56例,骨巨细胞瘤40例,软骨肉瘤12例,转移瘤8例,恶性纤维组织细胞瘤6例,尤文肉瘤2例,纤维肉瘤1例,动脉瘤样骨囊肿1例。肿瘤部位：股骨远端43例,胫骨近端42例,股骨近端2

2、4例,肱骨上段7例,骨盆9例,桡骨远端1例。以术后第3年、5年、7年为观察点,观察假体生存情况,以3年及5年为观察点,观察并发症发生情况。结果：126例患者34例次出现不同类型的并发症,发生率为26.98%。并发症包括：假体松动8例,假体断裂7例,假体关节脱位6例,假体周围骨折5例,假体周围深部感染3例,刀口愈合不良3例,腓总神经损伤2例。各部位并发症发生率：骨盆55.6%,胫骨近端28.6%,股骨远端25.6%,股骨近端20.8%,肱骨近端14.2%。本组假体总体累积生存率3年80.5%。5年68.5%,7年59.7%；按部位计3年假体累积生存率为股骨近端88.9%,股骨远端86.6%,胫骨

3、近端70.0%,肱骨近端75.0%,骨盆假体77.7%；5年假体累积生存率为股骨近端76.2%,股骨远端73.5%,胫骨近端53.7%,肱骨近端75.0%,骨盆假体50.0%；7年假体累积生存率为股骨近端61.0%,股骨远端58.8%,胫骨近端48.8%,肱骨近端75.0%,骨盆假体缺如。术后3年以内21例出现并发症,3-5年3例,5年以上10例。结论：并发症的发生和假体的生存与手术部位及假体类型有关。并发症发生率由高到低依次为骨盆,胫骨近端,股骨远端,股骨近端,肱骨近端。5年假体累积生存率由高到低依次为股骨近端,肱骨近端,股骨远端,胫骨近端,骨盆假体。以术后第3年、5年为观察点,可见并发症发

4、生相对集中在术后3年以内和5年以上两个时间段内。【英文摘要】:To retrospectively study the survival rate and incidence of complications related to prosthesis and surgery after resection of bone tumors and custom-made prosthesis reconstruction and to preliminarily analyze the reasons, discuss the factors on which we should focus d

5、uring the surgery and peri-postoperative period.Data and methods:We retrospectively reviewed 126 patients who underwent resection of bone tumors and custom-made prosthesis reconstruction between 1996 and 2007. Survival rates and complications were observed. Average follow-up was 51 months (range:3-1

6、24 months). There are 78 male patients and 48 female.Grouping the patients by pathology:56 with osteosarcoma,40 with GCT(giant cell tumor of bone),12 with chondrosarcoma,8 with metastatic tumor,6 with malignancy fibrohistiocytoma,2 with Ewing sarcoma,1 with fibrosarcoma,1 with aneurismal bone cyst.G

7、rouping the patients by the location:43 in distal femur,42 in proximal tibia,24 in proximal femur,7 in proximal humerus,9 in pelvis,1 in distal radius.Results:The prosthetic complications rate was 26.98% (34/126). Of 34 instances of complications,8/34 were loosening,7/34 breakage,6/34 dislocation,5/

8、34 fracture,3/34 infection,3/34 nonunion,2/34 common peroneal nerve injury. The incidence of complications was 55.6%,28.6%,25.6%,20.8% and 14.2% in pelvis, proximal tibia, distal femur, proximal femur and proximal humerus respectively. According to operative site, the survival of total prosthesis is

9、 80.5%in 3years,68.5% in 5years and 59.7% in 7 years.The 3 years overall prosthesis survival was 88.9% in proximal femur,86.6% in distal femur,70.0% in proximal tibia,75% in proximal humerus,77.7% in pelvis. The 5 years overall prosthesis survival was 76.2% in proximal femur,73.5% in distal femur,53

10、.7% in proximal tibia,75% in proximal humerus,50% in pelvis. The 7 years overall prosthesis survival was 61% in proximal femur,58.8% in distal femur,48.8% in proximal tibia,75% in proximal humerus.21 complications ocurred in 3 years,3 in 3-5 years,10 after 5 years. Conclusion: Incidence of complicat

11、ions and survival was related to operative site and prosthesis type. The rank of incidence of complications is pelvis, proximal tibia, distal femur, proximal femur and proximal humerus from high to low. The rank of 5 years overall prosthesis survival was proximal femur, proximal humerus, distal femur, proximal tibia and pelvis from high to low. The incidence of complications relatively concentrated in less than 3 years and more than 5 years after operation.【关键词】骨肿瘤 定制假体 并发症 生存分析【英文关键词】Bone neoplasm custom-prothesis