Rotating hinge prosthesis replacement for treatment of malignant bone tumors of the distal femur: evaluation of limb function and survival rate

doi:10.3969/j.issn.2095-4344.2014.04.006

Abstract

Abstract:

BACKGROUND: Distal femur is a predilection site for primary bone tumors, most of which are treated with salvage treatment. There are many reports on the early-stage, mid-term and prognosis of the distal femur tumor-type artificial knee joint prosthesis, but reports on long-term function and prognosis are less.

OBJECTIVE: To study the long-term prognosis and limb function after treatment with rotating-hinge knee prosthesis.

METHODS: Thirty-four patients with distal femoral bone tumors admitted to the Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University between January 2000 and June 2008 were retrospectively analyzed, including 19 males and 15 females. All patients were subjected to rotating hinge knee prosthesis replacement.

RESULTS AND CONCLUSION: The mean follow-up period was 62.4 months (range 11 to 126 months). At the final of follow-up, 23 patients were event-free alive and 11 patients were dead. Seven of 23 survival patients suffered from prosthesis related complications, including four cases of prosthesis revision and three cases of amputation. The event-free survival rate of 23 patients undergoing replacement of domestic tumor prosthesis around the knee was 67.6% in 5 years. The mean functional score of affected limb was 19.30 (7 to 27 points): excellent in 6 cases, good in 16, fine in 5 and poor in 2. The excellent-good rate was 75.9%. The clinical outcomes suggested that the satisfactory limb function and survival rate could be achieved with the application of domestic tumor prosthesis replacement for treatment of malignant bone tumors around the knee.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: prosthesis implantation, joint prosthesis, bone neoplasms, soft tissue infections, knee prosthesis

CLC Number:

R318

Jiang Zheng, Yin Zong-sheng, Hu Yong, Liu Bi-quan, Wang Wei. Rotating hinge prosthesis replacement for treatment of malignant bone tumors of the distal femur: evaluation of limb function and survival rate[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(4): 523-528.

Figures/Tables 2

2.1 受试者数量分析共统计2000年1月至2008年6月安徽医科大学第一附属医院骨科股骨远端恶性骨肿瘤外科治疗的患者34例，均获得随访，无中间补充以及失访患者。29例患者在置换后2年进行膝关节假体评分(5例患者在2年前已死亡)。全部23例患者获得长期随访，最终34例患者进入结果分析。 2.2 置换后患者生存率变化 34例患者平均随访62.4个月(11-126个月)，23例患者生存，11例患者死亡(骨肉瘤8例，软骨肉瘤2例，骨转移瘤1例)，肿瘤型膝关节假体患者的5年生存率为67.6%。 2.3 置换后患者死亡及生存例数分析 11例死亡患者，其中ⅡA期19例死亡4例，ⅡB期14例死亡6例，Ⅲ期1例死亡1例。将ⅡA期与ⅡB期患者死亡率比较差异无显著性意义(P > 0.05)。 EnnekingⅡ期患者中无病理性骨折患者25例中死亡7例；有病理性骨折患者8例中死亡3例。将两组患者死亡率比较差异无显著性意义(P > 0.05)。 23例生存患者平均随访86个月(62-126个月)，17例仍保留原假体；5例发生假体松动(其中4例行翻修，1例行截肢)；1例因反复感染及窦道形成行截肢。 2.4 置换后患者膝关节功能变化 29例患者在置换后2年时行膝关节假体评分(Enneking评分系统)，总体平均评分为19.3分(7-27分)：优6例，良16例，中5例，差2例，患者假体功能总的优良率为75.9%。 2.5 置换后不良反应及生物相容性分析 23例生存患者出现5例假体松动，考虑可能原因为聚乙烯碎屑激活巨噬细胞与成纤维细胞的作用最强，由其磨损产生的碎屑激发的生物反应和免疫反应可引发破骨细胞对假体周围骨组织的破坏，常导致在没有感染的情况下发生植入物的无菌性松动，甚至导致骨溶解，造成假体置入失败。 2.6 典型病例 17岁男性患者，置换前经病理证实诊断为右股骨远端骨肉瘤，置换前X射线及MRI检查显示病变范围，确定截骨长度，根据截骨长度确定假体长度与厂家定制假体。术中根据置换前确定截骨平面进行截骨，并安装假体。置换后3个月复查X射线显示假体位置良好(图1)。"

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