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下肢肿瘤型人工关节无菌性松动的翻修治疗

Revision for Aseptic Loosening of Tumor Prosthesis in Lower Limbs

  • 摘要:
    目的  确定GMRS肿瘤型人工关节翻修后的假体生存率和患者的肢体功能。
    方法  回顾性分析2009—2012年16例下肢人工关节无菌性松动并接受GMRS肿瘤型人工关节翻修患者的临床资料。Kaplan-Meier计算人工关节的5年和8年存活率。MSTS功能评分量表评估患者的肢体功能。
    结果  平均随访90个月(52~118个月),GMRS肿瘤型人工关节的5年和8年的假体生存率均为94%。有2例翻修术后失败,其中1例感染和1例再次无菌性松动。第1次关节置换和翻修手术之间的平均间隔为81个月(27~187个月)。至最后一次随访,93.3%(14/15)患者未出现再次无菌性松动、85.7%(12/14)患者经GMRS人工关节翻修后无松动生存时间(90.6±19.3个月)明显长于第一次关节置换的假体无松动时间(43.4±29.7个月),差异有统计学意义(P=0.001)。平均MSTS功能评分为27.7(24~30)。
    结论  GMRS人工关节在下肢肿瘤翻修术中出现再次松动的发生率低,患者肢体功能良好,具有满意的中长期疗效。

     

    Abstract:
    Objective  To determine the prosthesis survival and limb function after revision of global modular replacement system (GMRS) tumor prosthesis.
    Methods  We retrospectively analyzed the clinical data of 16 patients who developed aseptic loosening of lower extremity tumor prosthesis and subsequently received revision with GMRS from 2009 to 2012. Kaplan-Meier method was used to calculate the 5- and 8-year survival rates of the prosthesis. The MSTS function scale was used to evaluate the functional outcomes.
    Results  The average follow-up time was 90 months (52-118 months). The 5- and 8-year survival rates of GMRS prosthesis were both 94%. After revision, two patients failed, including one case of infection and one case of repeated aseptic loosening. The average interval between the first joint replacement and revision surgery was 81 months (27-187 months). Until the last follow-up, 93.3%(14/15) of the patients did not develop repeated aseptic loosening, 85.7%(12/14) of the patients who underwent GMRS revision had a longer loosening-free survival than those with the primary joint replacement (90.6±19.3 vs. 43.4±29.7 months, P=0.001). The average MSTS functional score was 27.7(24-30).
    Conclusion  The incidence of repeated aseptic loosening for GMRS prosthesis is low and the limb function is good. The reported technique is satisfactory in the middle and long term.

     

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