1、.骨腫瘤論文：定制腫瘤型假體置換術后假體生存及并發癥的發生和原因分析【中文摘要】回顧性研究定制腫瘤型假體置換術后假體生存及與假體及手術相關的并發癥的發生,并對其產生原因進行初步分析,討論手術期間需注意的問題。資料與方法：對1996年4月-2007年4月完成的126例定制腫瘤型假體置換術后患者進行隨訪,時間3-124個月,平均51個月。男78例,女48例,年齡11-72(33.7±16.5)歲。腫瘤類型：骨肉瘤56例,骨巨細胞瘤40例,軟骨肉瘤12例,轉移瘤8例,惡性纖維組織細胞瘤6例,尤文肉瘤2例,纖維肉瘤1例,動脈瘤樣骨囊腫1例。腫瘤部位：股骨遠端43例,脛骨近端42例,股骨近端2

2、4例,肱骨上段7例,骨盆9例,橈骨遠端1例。以術后第3年、5年、7年為觀察點,觀察假體生存情況,以3年及5年為觀察點,觀察并發癥發生情況。結果：126例患者34例次出現不同類型的并發癥,發生率為26.98%。并發癥包括：假體松動8例,假體斷裂7例,假體關節脫位6例,假體周圍骨折5例,假體周圍深部感染3例,刀口愈合不良3例,腓總神經損傷2例。各部位并發癥發生率：骨盆55.6%,脛骨近端28.6%,股骨遠端25.6%,股骨近端20.8%,肱骨近端14.2%。本組假體總體累積生存率3年80.5%。5年68.5%,7年59.7%；按部位計3年假體累積生存率為股骨近端88.9%,股骨遠端86.6%,脛骨

3、近端70.0%,肱骨近端75.0%,骨盆假體77.7%；5年假體累積生存率為股骨近端76.2%,股骨遠端73.5%,脛骨近端53.7%,肱骨近端75.0%,骨盆假體50.0%；7年假體累積生存率為股骨近端61.0%,股骨遠端58.8%,脛骨近端48.8%,肱骨近端75.0%,骨盆假體缺如。術后3年以內21例出現并發癥,3-5年3例,5年以上10例。結論：并發癥的發生和假體的生存與手術部位及假體類型有關。并發癥發生率由高到低依次為骨盆,脛骨近端,股骨遠端,股骨近端,肱骨近端。5年假體累積生存率由高到低依次為股骨近端,肱骨近端,股骨遠端,脛骨近端,骨盆假體。以術后第3年、5年為觀察點,可見并發癥發

4、生相對集中在術后3年以內和5年以上兩個時間段內。【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.【關鍵詞】骨腫瘤 定制假體 并發癥 生存分析【英文關鍵詞】Bone neoplasm custom-prothesis