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1、77例膝关节肿瘤保肢假体置换的临床观察作者：张兴琳，李世德，姜连红，邹本国，廖光军【摘要】［目的］总结膝关节肿瘤保肢手术不同假体置换的术后比较及评价标准的效能。［方法］86例膝关节肿瘤中，失访9例，余77例中40例采用单纯铰链式假体置换(A组)，25例采用旋转铰链式假体置换（B组），12例采用半关节置换(C组)。77例平均随访3年6个月，按Enneking膝关节评分标准(见表1)、ambulationscores（见表2）及感染、复发、转移死亡进行评估。［结果］A组：复发5例，转移死亡3例(均为骨肉瘤)，感染2例
2、；B组：复发3例，转移死亡2例(1例为恶性纤维组织细胞瘤,余4例为骨肉瘤)，感染1例；C组：复发1例，转移死亡1例(均为骨肉瘤)感染1例。各组无假体松动病例。去除复发及转移死亡病例后,剩62例,A组32例，B组18例，C组10例。A、B组Enneking评分P>0.05，无显著性差异；A、C及B、C组P<0.05，有显著性差异；Ambulationscores各分项及总分均P<0.05，有显著性差异。［结论］各组在术后并发症方面短期未见显著差别，但在术后功能方面Ambulationscores旋
3、转铰链假体置换明显优于单纯铰链式假体置换和半关节置换,而Enneking则没能体现出前两组术后功能方面的显著性差异。因此Ambulationscores更适合对膝关节保肢术后功能评价。【关键词】膝关节;肿瘤;假体;置换11Abstract:［Objective］Toinvestigateandcomparetheeffectsafterresectionoftumorsroundthekneesandtodiscusstheevaluationcriteria.［Method］Of86patientswithtu
4、morroundtheknees,77werefollowedupforanaverageof3.5years.Fortykneesin４0patientsunderwenttotalkneereplacementusinghinge-kneesysterm（groupA）,25knessin25patientsunderwenttotalkneereplacementusingrotatingkneesysterm（groupB）,and12kneesunderwentsemi-replacementin12p
5、atients(groupC).AssessmentwasdonewithEnnekingfunctionalscores,ambulationscores,flexion-extension-angle,kneerotationandinfection,recurrence,andoperativetime.［Result］IngroupA,therewere5casesofrecurrence,3casesofmetastasis/death,and2casesofinfection.IngroupB,the
6、rewere3casesofrecurrence,2casesofmetastasis/death,and2casesofinfection.Noprosthesisflexiblewasinbothgroups.Apartfromthecasesofrecurrenceandmetastasis/death,therewere32casesingroupA,20casesingroupB,and10casesingroupC.Ennekingscoreshadnosignificantdifference(P&
7、gt;0.05)betweengroupAandB,butsignificantdifferencebetweenAandCorbetweenBandC(P>0.05).Ambulationscoresrevealedsignificantdifference(P<110.05)betweengroups.［Conclusion］Therewerenoinnediatedifferenceincomplicationsbetweengroups.Ambulationscoresshowedthatro
8、tationkneesystemissuperiortotheothertwosystems.Itismoreusefultoevaluatethefunctionafterkneesalvage.Keywords：kneejoint;tumor;prosthesis;replacement膝关节部位为骨肿瘤的好发部位。1988年Dahlin报道5116例骨肿瘤中膝关节1
