文章摘要
邹龙飞,郭江,薛浩,郑舒凌,张建华,吕辉,黄邓华,谭美云.定制型限制性假体治疗肘关节周围恶性肿瘤骨破坏.骨科,2020,11(6):506-512
定制型限制性假体治疗肘关节周围恶性肿瘤骨破坏
Treatment of peri-elbow malignant bone destruction with customized constrained elbow prosthesis
投稿时间:2020-06-16  
DOI:10.3969/j.issn.1674-8573.2020.06.008
中文关键词: 恶性肿瘤  肘关节假体  肘关节置换  效果研究
英文关键词: Malignant tumor  Elbow prosthesis  Elbow arthroplasty  Efficacy research
基金项目:
作者单位E-mail
邹龙飞 西南医科大学附属医院骨与关节外科四川泸州 646000  
郭江 西南医科大学附属医院骨与关节外科四川泸州 646000  
薛浩 西南医科大学附属医院骨与关节外科四川泸州 646000  
郑舒凌 西南医科大学附属医院骨与关节外科四川泸州 646000  
张建华 西南医科大学附属医院骨与关节外科四川泸州 646000  
吕辉 西南医科大学附属医院骨与关节外科四川泸州 646000  
黄邓华 西南医科大学附属医院骨与关节外科四川泸州 646000  
谭美云 西南医科大学附属医院骨与关节外科四川泸州 646000 drtmy@126.com 
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中文摘要:
      目的 探讨定制型限制性假体治疗肘关节周围恶性肿瘤骨破坏的临床疗效。方法 回顾性分析我院2014年6月至2019年10月收治的7例肘关节周围恶性肿瘤骨破坏行定制型限制性全肘关节假体置换的病人的临床资料,其中男3例,女4例,年龄为(61.7±16.7)岁(28~79岁),病程为(5.4±2.8)个月(2~10个月)。肱骨5例,尺骨2例;骨肉瘤2例,平滑肌肉瘤1例,软骨肉瘤2例,骨巨细胞瘤2例;Enneking分期ⅠA 1例,ⅠB 2例,ⅡA 2例,ⅡB 2例。记录病人术前、出院及末次随访时的Mayo肘关节功能评分(Mayo elbow performance score, MEPS)、美国特种外科医院(American Hospital for Special Surgery, HSS)肘关节评分、疼痛视觉模拟量表(visual analogue scale, VAS)评分、肘关节活动度及影像学复查结果。结果 所有病人顺利完成手术,均获得随访,手术时间为(119.7±18.3) min(95~150 min),术中出血量为(205.7±62.7) ml(120~300 ml),随访时间为(33.4±21.4)个月(6~70个月)。病人术前、出院及末次随访时的MEPS评分为(45.29±12.91)分、(73.43±8.32)分和(85.29±4.82)分,HSS评分为(47.29±12.58)分、(74.14±8.80)分和(85.71±5.44)分,VAS评分为(6.86±1.35)分、(2.57±0.98)分和(1.71±0.95)分,肘关节屈伸范围为53.29°±14.74°、76.00°±8.77°和101.14°±12.28°,旋前旋后范围为102.14°±16.55°、112.86°±14.10°和124.29°±12.05°,差异均有统计学意义(P均<0.05)。本研究随访中,2例病人死于肿瘤全身转移,1例病人因肿瘤局部复发行截肢术,其余病例情况良好,未出现肿瘤复发及转移。结论 定制型限制性假体联合化疗对肘关节周围恶性肿瘤骨破坏是一个较好的保肢治疗手段,延长病人生存时间,但也应该严格把控手术指征和原则,术中注意保护尺神经和肱三头肌,完整切除肿瘤组织,术后严格化疗,控制肿瘤复发是治疗成功的关键。
英文摘要:
      Objective To evaluate the effectiveness of customized constrained elbow prosthesis for peri-elbow bone destruction by malignant tumor. Methods The clinical data of patients admitted to our department from June 2014 to October 2019 undergoing customized constrained elbow prosthesis arthroplasty were collected. Totally, 7 patients were included in this research, including 3 males and 4 females, with an age of (61.7±16.7) years old (28-79 years). Duration of the disease was (5.4±2.8) months (2-10 months). The suffering sites were humerus in 5 cases, and ulna in 2 cases. There were 2 cases of osteosarcoma, 1 case of leiomyosarcoma, 2 cases of chondrosarcoma, 2 cases of giant cell tumor of bone. Based on the Enneking staging system, there were 1 case in stage ⅠA, 2 in stage ⅠB, 2 in stage ⅡA and 2 in stage ⅡB. Mayo elbow performance score (MEPS), American Hospital for Special Surgery (HSS) assessment scale, visual analogue scale (VAS), the elbow range of motion and radiographs before operation, after discharge and at last follow-up were analyzed statistically. Results All surgeries were successfully completed and followed up. The surgery time was (119.7±18.3) min (95-150 min). The bleeding volume of surgery was (205.7±62.7) ml (120-300 ml). The patients were followed up for (33.4±21.4) months (6-70 months). The scores of MEPS preoperation, after discharge and at last follow-up were 45.29±12.91, 73.43±8.32 and 85.29±4.82, those of HSS were 47.29±12.58, 74.14±8.80 and 85.71±5.44, those of VAS were 6.86±1.35, 2.57±0.98 and 1.71±0.95, the elbow flexion and extension range was 53.29°±14.74°, 76.00°±8.77° and 101.14°±12.28°, pronation and supination range was 102.14°±16.55°, 112.86°±14.10° and 124.29°±12.05°, respectively, and all the differences were statistically significant (all P<0.05). All cases were alive with prostheses in good condition, except 2 patients died for systemic metastasis and 1 patient underwent amputation for local tumor relapse. Conclusion The customized constrained elbow prosthesis combined with chemotherapy is a good limb-sparing strategy for malignant bone tumors around elbow, and to prolong the life time of patients. But the indications for operation should be restricted for proper candidates, operation principles be seriously followed, and attention should be paid to the protection of ulnar nerve and triceps brachii during operation. Also chemotherapy after operation should be timely added to avoid recurrence of tumor, which is the key to successful treatment.
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