新轴心式假体治疗膝关节周围恶性肿瘤骨破坏

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Abstract

Objective To evaluate the effectiveness of newly designed pivoted knee prosthesis for peri-knee bone destruction by malignant tumor.Methods Clinic materials of patients admitted to our department between January 2012 and July 2018 and underwent customized newly designed pivoted knee prosthesis arthroplasty were collected.10 cases of patients were included in this research，including 4 male and 6 female，with an average age of (45.6±18.1)years old (Range 17 to 69 y).Duration of the disease was (3.7±1.6)months (Range 1 to 6 months).There were 2 osteosarcoma，1 chondrosarcoma，3 giant cell tumor，2 leiomyosarcoma and 2 other cases.The suffering sites were femur in 3 cases，tibia in 6 cases and both sites in 1 case.Based on the Enneking staging system，there were 1 case in stage ⅠA，3 in stage ⅠB，2 in stage ⅡA and 4 in stage ⅡB.Visual Analogue Scale (VAS)，Hospital for special surgery knee score (HSS) and American knee society knee score (KSS) before operation，discharging and last follow-up were collected and analyzed statistically.Meanwhile，the results of musculoskeletal tumor society system (MTSS) and radiographs were observed and analysed at last follow-up.Results All surgeries were successfully completed.No surgery plan change happened.the average surgery time was 181.0±36.3 min with bleeding volume of (227.5±59.0)mL in operation.The patients were followed up for (25.3±19.9)months (range：3 to 68 months).The scores of VAS at preoperation，discharging and last follow-up periods were (6.30±1.16)，(2.40±0.84) and (1.90±0.74)(F＝66.962，P＜0.05)；HSS were (42.50±4.04)，(62.40±4.45)and (73.6±3.78)(F＝147.782，P＜0.05)；KSS were (37.30±3.83)，(68.60±2.32) and (76.10±4.56)(F＝311.274，P＜0.05)，respectively.The last follow-up scores of MTSS were (23.10±2.33).All cases were alive with prostheses in good condition，excluding 1 patient received revision for disalignment of prosthesis，1 patient underwent amputation for local tumor relapse and 2 patients died for systemic metastasis.Conclusion The customized newly designed pivoted knee prosthesis is a good limb-sparing strategy for malignant bone tumors around knees.But，the indications for operation should be restricted for proper candidates，operation principles be seriously followed and also chemotherapy after operation be timely added to avoid recurrence of tumor.

Key words： malignant tumor pivoted knee prosthesis knee arthroplasty efficacy research

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