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-  2015 

腓骨小头切除对胫骨上段肿瘤人工关节重建保肢术疗效的影响分析

DOI: doi:10.7507/1002-1892.20150154

Keywords: 骨肿瘤, 胫骨上段, 腓骨小头, 人工关节, 功能重建, 保肢手术

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Abstract:

目的探讨胫骨上段肿瘤行人工关节重建保肢术中切取腓骨小头对疗效的影响。 方法1999年7月-2013年3月,对76例胫骨上段肿瘤患者行保肢术。术中行瘤段切除、人工全膝关节重建,腓肠肌内侧头肌瓣覆盖,其中38例同时切除腓骨小头(A组),38例保留腓骨小头(B组)。两组患者性别、年龄、侧别、肿瘤类型及分期、病程比较,差异均无统计学意义(P>0.05),具有可比性。观察比较两组术后相关并发症发生情况,X线片观察假体位置,采用1993年美国骨肿瘤学会评分系统(MSTS93)评定关节功能。 结果患者均获随访,随访时间12~150个月,平均87个月。术后A组1例(2.63%)发生切口感染,显著低于B组6例(15.79%)(χ2=3.934,P=0.047)。A组1例、B组2例发生腓肠肌内侧头坏死。X线片复查示A组4例、B组6例发生假体松动;A组2例、B组4例存在膝关节不稳。A组3例、B组5例肿瘤局部复发,A组7例、B组6例发生远处转移,A组8例、B组7例因肿瘤复发死亡。术后12个月,根据MSTS93评分系统,A组获优23例,良10例,中3例,差2例,优良率为86.84%;B组获优21例,良11例,中3例,差3例,优良率为84.21%。两组优良率比较,差异无统计学意义(χ2=0.106,P=0.744)。 结论胫骨上段肿瘤行人工关节重建保肢手术时,切除腓骨小头有利于术中软组织覆盖,可减少植皮术创伤及相应并发症,降低术后感染率,术后关节稳定性及活动度良好

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