影响瘤段切除组配式假体重建膝关节功能的因素

Factors impacting function after wide resection and modular megaprosthetic replacement for aggressive bone tumors around the knee

摘要:

[目的]探索影响瘤段切除组配式假体重建膝关节功能的因素。[方法]回顾性分析 2015 年 1 月—2021 年 6 月采用瘤段切除组配式肿瘤型膝关节假体重建治疗膝周侵袭性骨肿瘤 31 例患者的临床资料。随访其临床结果，测量并计算截骨长度比 （osteotomy length ratio, OLR）、髓内-髓外比 （internal-external medulla ratio, IEMR）、双侧肢体长度差 （leg-length discrepan- cy, LLD）和股胫机械轴角（femorotibial mechanical axis angle, MAA）。按肿瘤部位、体质、肿瘤性质分组比较，行临床与影像资料相关性分析。[结果] 31 名患者均顺利完成手术，无严重术中并发症，手术时间 （174.0±54.7） min、术中失血量 （388.7± 260.6）ml、切口长度（28.1±4.3）cm。所有患者随访平均（39.3±18.9）个月，2 例出现肺转移、1 例全身多发转移、2 例局部复发。末次随访时，SF-36 评分（129.3±29.0），MSTS 评分（22.3±4.7），TESS 评分（112.1±14.9），KSS 功能评分（64.0±19.4）。影像方面，OLR（38.0±8.1）%、IEMR（112.4±29.1）%、LLD（35.5±132.6）mm、 MAA（178.3±1.3）°。无瘤生存率（87.1%）、假体生存率（96.8%）。按肿瘤部位、患者体质、肿瘤性质分组比较 SF-36、MSTS、TESS 和 KSS 评分的差异均无统计学意义（P＞ 0.05）。Pearson 相关分析表明，SF-36 与 OLR（r=-0.596, P＜0.001），TESS 与 LLD（r=-0.495, P=0.005）、MSTS 评分与 OLR（r=- 0.568, P=0.001） 及 LLD （r=-0.368, P=0.044）、KSS 与 LLD （r=-0.457, P=0.010） 均呈显著负相关，但是，所有临床评分与 IEMR、MAA 没有相关性 （P＞0.05）。[结论] 国产组配式肿瘤型膝关节假体，能使患者获得良好的生活质量与功能恢复； OLR、LLD 与术后生活质量、功能有明显相关性。

Abstract:

[Objective] To explore the factors affecting function after wide resection and modular megaprosthetic replacement for ag- gressive bone tumors around the knee. [Methods] A retrospective study was performed on 31 patients who underwent wide resection and modular megaprosthetic replacement for aggressive bone tumor around the knee. The clinical consequences were observed by follow up, and radiographical measurements, including the osteotomy length ratio (OLR), internal- external medulla ratio (IEMR) and bilateral leg length discrepancy (LLD), and femorotibial mechanical axis angle (MAA) were recorded. The patients grouped according to tumor site, con- stitution and tumor feature were compared, and the correlation analysis was performed between clinical and imaging data. [Results] All the 31 patients were successfully operated on without serious intraoperative complications, whereas with operation time of (174.0±54.7) min, the intraoperative blood loss of (388.7±260.6) ml, and the incision length of (28.1±4.3) cm. During the follow-up period lasted for an aver- age of (39.3±18.9) months, 2 cases of lung metastasis, 1 case of multiple systemic metastasis and 2 cases of local recurrence were found and treated respectively. At the last follow-up, the clinical scores were recorded as SF-36 score of (129.3±29.0), MSTS score of (22.3±4.7), TESS score of (112.1±14.9), and KSS functional score of (64.0±19.4), additionally, the radiographical parameters were measured as OLR of (38.0±8.1)%, IEMR of (112.4±29.1)%, LLD of (35.5±132.6) mm and MAA of (178.3±1.3)°. At the latest follow-up, the tumor free survival rate was of 87.1%, while the prosthetic survival rate was of 96.8%. In term of grouping comparison, there was no significant difference re- garding of SF-36, MSTS, TESS, and KSS scores among groups by tumor site, patient constitution, and tumor feature (P＞0.05). As results of Pearson correlation analysis, significantly negative correlation were noticed between the SF-36 score and OLR (r=-0.596, P＜0.001), TESS score and LLD (r=-0.495, P=0.005), MSTS score and OLR (r=-0.568, P=0.001), MSTS and LLD (r=-0.368, P=0.044), as well as KSS score and LLD (r=-0.457, P=0.010). However, all the clinical scores were not correlated with IEMR and MAA (P＞0.05). [Conclusion] This wide resection and modular megaprosthetic replacement do effectively treated aggressive bone tumors around the knee with benefits of improving patients' quality of life and functional recovery. However, the OLR and LLD were significantly correlated with postoperative qual- ity of life and function.