目的 探讨肿瘤型假体置换患者术中应用人工补片修复关节囊及软组织的方法及临床价值.方法 收集2013年1月至2015年6月接受肿瘤型假体和人工补片重建的51例患者的临床资料,其中男27例,女24例,年龄为(44.75±23.18)岁.肩关节置换5例,肘关节置换2例,髋关节置换12例,膝关节置换32例(其中股骨侧肿瘤24例,胫骨侧肿瘤8例).转移瘤12例,骨肉瘤20例,软骨肉瘤7例,恶性纤维组织细胞瘤5例,骨巨细胞瘤4例,尤文肉瘤1例,平滑肌肉瘤1例,色素沉着绒毛结节性滑膜炎1例.患者行肿瘤广泛切除术、肿瘤型人工假体置换、人工补片修复关节囊和包绕假体体部,分析患者的治疗效果.结果 全部患者随访时间为(19.75±8.17)个月,平均术后4 d拔除引流管.浅表切口感染2例,深部感染1例,小腿前侧肌群骨筋膜室综合征1例,未发生假体及关节脱位和假体感染.肩关节置换术后患者肩关节前屈角度为(34.00±10.84)°,外展角度为(20.00±9.35)°,骨与软组织肿瘤协会(MSTS)评分为(19.80±9.54)分,优良率为0.肘关节置换术后患者肘关节屈曲角度为(75.00±7.07)°,伸直角度为(-5.00±7.07)°,MSTS评分为(25.00±2.83)分,优良率为50.0%(1/2).髋关节置换术后患者髋关节屈曲角度为(86.67±20.60)°,后伸角度为(2.08±4.98)°,MSTS评分为(25.42±1.78)分,优良率为83.3%(10/12).膝关节置换术后患者膝关节屈曲角度为(89.69±22.39)°,伸直角度为(-0.63±1.68)°,MSTS评分为(23.31±2.09)分,优良率50.0%(16/32),其中股骨侧优良率为66.7%(16/24),胫骨侧优良率为0.全组患者对治疗结果满意.结论 应用人工补片修复肿瘤关节假体置换后的关节囊及软组织,可促进假体与自身组织融合,增加人工关节的稳定性,降低脱位率,重建肌腱与假体附着点恢复肌肉动力.对软组织缺损后的关节稳定性和动力重建有重要作用,有效地降低手术并发症.%Objective To investigate the operative method and clinical application of the BARD Mesh in enhancing joint stability and function of endoprosthetic reconstruction for bone tumors.Methods From Jan 2013 to Jun 2015, the clinical data of 51 patients aged (44.75±23.18) years underwent wide resection of tumor and endoprosthetic reconstruction using the BARD Mesh were collected.Among them, 27 were male and 24 were female.The surgical treatments received by these patients included 5 shoulder arthroplasties, 12 elbow replacements, 12 hip replacements and 32 knee replacements (including 24 femoral tumors and 8 tibial tumors).According to the pathologic type, there were 12 metastatic tumors, 20 osteosarcomas, 7 chondrosarcomas, 5 malignant fibrous histiocytomas, 4 giant cell tumors of bone, 1 Ewing sarcoma, 1 leiomyosarcoma and 1 pigmented villonodular synovitis (pvns).These patients received extensive tumor resection, tumorous prosthesis replacement, preserved articular capsule and muscles repair with artificial mesh and endoprosthesis wrapping.The curative effect including joints range of motion and Musculoskeletal Tumour Society Scores (MSTS) were evaluated.Results The median follow-up time was (19.75±8.17) months.The drainages were removed out on an average of 4 days after operation.The postoperative complications included 2 superficial incision infection, 1 deep incision infection and 1 osteofascial compartment syndrome, infection or dislocation of prosthesis wasn′t observed.The mean active flexion of shoulder joint after replacement was (34.00±10.84)°, mean active abduction was (20.00±9.35)° and the mean MSTS was 19.80±9.54.The superior rate of shoulder flexion function was 0.The mean active flexion of elbow joint after replacement was (75.00±7.07)°, mean active abduction was (-5.00±7.07)° and the mean MSTS was 25.00±2.83.The superior rate of elbow flexion function was 50.0% (1/2).The mean active flexion of hip joint after replacement was (86.67±20.60)°, mean active abduction was (2.08±4.98)° and the mean MSTS was 25.42±1.78.The superior rate of hip flexion function was 83.3% (10/12).The mean active flexion of knee joint after replacement was (89.69±22.39)°, mean active abduction was (-0.63±1.68)° and the mean MSTS was 23.31±2.09.The superior rate of knee flexion function was 50.0%(16/32).Among them, the superior rate of femoral flexion function was 66.7% (16/24), the superior rate of tibial flexion function was 0.All of patients were satisfied with the curative effect of operation at the end of follow-up time.Conclusions The BARD Mesh may enhance the attachment of soft-tissue to endoprosthesis, improve the joint stability, decrease the endoprosthetic infection and dislocation, facilitate the attachment of tendon to endoprosthesis and recover the muscular motivation after endoprosthetic reconstruction.This plays an important role in joint stability and motivation reconstruction of soft-tissue impairment, effectively prevents surgical complications.
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