摘要
目的探讨膝关节周围骨巨细胞瘤患者行不同手术方式后的膝关节功能和生活质量。方法回顾分析2002年3月至2020年6月,解放军联勤保障部队第九六〇医院骨科行保肢手术的40例患者的临床资料、影像学资料、随访资料完整的,膝关节周围骨巨细胞瘤患者。男21例,女19例;年龄16~60(34.90±11.04)岁,病变部位股骨远端22例,胫骨近端18例。按照手术方式分为两组,其中行肿瘤刮除术的28例为保留关节组,行瘤段切除假体重建术的12例患者为假体置换组;另选取2021年3月至2021年6月,在我科陪护的28名健康成年人作为正常对照组,其中男、女各14例,年龄25~43(33.61±5.66)岁。于末次随访时(时间至少为术后1年),分别对上述3组研究对象采用国际骨与软组织肿瘤协会(Musculoskeletal Tumor Society,MSTS)评分、国际膝关节委员会膝关节主观评分量表(The International Knee Documentation Committee Knee Evaluation form,IKDC)、健康调查简表(The MOS 36-Item Short Form Health Survey,SF-36)进行评价,比较保留关节组、假体置换组和正常对照组膝关节功能、下肢功能及生活质量的状况,并比较保留关节组和假体置换组分别在上述评分量表中各条目的差异。结果3组研究对象年龄、性别、病变部位、末次随访时间等基本临床资料比较,差异均无统计学意义(P>0.05)。MSTS评分,保留关节组(25.79±3.94)、假体置换组(22.5±6.72),差异有统计学意义(H=42.09,P<0.05),保留关节组在肢体功能、满意程度、支具辅助、行走状况及步态方面均优于假体置换组,但在疼痛方面较假体置换组差,且差异均有统计学意义(P<0.05)。IKDC评分,3组分别为:正常对照组(95.64±3.64)、保留关节组(63.79±12.99)、假体置换组(49.33±14.15),差异有统计学意义(H=52.31,P<0.05),除关节僵硬肿胀程度、有无绞索两个维度差异无统计学意义(P>0.05)外,其它方面保留关节组均优于关节置换组,且差异均有统计学意义(P<0.05)。SF-36评分的躯体健康(physical component summary,PCS)评分,正常对照组(89.06±7.89)、保留关节组(67.40±17.30)、假体置换组(58.00±18.37),差异有统计学意义(H=29.36,P<0.05);SF-36评分的精神健康(mental component summary,MCS)评分,3组分别是:正常对照组(91.26±6.20)、保留关节组(74.05±17.20)、假体置换组(73.78±24.04),差异有统计学意义(H=18.39,P<0.05);躯体疼痛(bodily pain,BP)和精神健康(mental health,MH)两个维度差异无统计学意义(P>0.05);假体置换组一般健康状况(general health,GH)、情感职能(role-emotional,RE)两个维度评分高于保留关节组,其它维度则反之,且差异均有统计学意义(P<0.05)。结论肿瘤刮除术相比瘤段切除假体重建术能给膝关节周围骨巨细胞瘤患者带来更好的下肢功能、关节功能及生活质量。应用IKDC、SF-36评分对于骨巨细胞瘤患者术后的评价具有可信度。
Objective To investigate different surgical strategies for giant cell tumor of bone(GCTB)around the knee joint,and to compare the postoperative knee function and quality of life of patients.Methods Clinical data of 40 patients(21 males and 19 females),who had received limb salvage surgery for GCTB around the knee joint in the department of the Orthopedics of the 960th hospital of PLA Joint Logistics Support Force from March 2002 to June 2020,were retrospectively analyzed.All patients had complete orthopedic clinical data,imaging data,and follow-up data.The age ranged from 16 to 60 years(mean:34.90±11.04 years).Lesion was located in the distal femur of 22 cases,while proximal tibia of 18 cases.According to the operation strategies,they were divided into two groups:joint reservation group and prosthesis replacement group.The former group included 28 patients who underwent the curettage of tumor,and the latter group included 12 patients who underwent the curettage of tumor and reconstruction with prosthesis.Meanwhile,28 healthy adults were selected as normal control group,including 14 males and14 females aged from 25 to 43 years(mean:33.61±5.66 years).During follow-up(at least 1 year after operation),all patients were evaluated using the Musculoskeletal Tumor Society(MSTS),The International Knee Documentation Committee Knee Evaluation form(IKDC),and The MOS 36-Item Short Form Health Survey(SF-36)to compare the knee function,lower limb function and quality of life of the joint reservation group,prosthesis replacement group and normal control group.Results There were no significant differences in age,gender,lesion location,and other basic clinical data among the three groups(P>0.05).The MSTS scores:joint reservation group(25.79±3.94);prosthesis replacement group(22.50±6.72);the differences were statistically significant(H=42.09,P<0.05).The limb function,emotional acceptance,supports,walking and gait of the joint preserving group were better than those of the prosthesis replacement group,but the pain was worse than that of the prosthesis replacement group with statistically significant differences(P<0.05).The IKDC scores:normal control group(95.64±3.64);joint reservation group(63.79±12.99);prosthesis replacement group(49.33±14.15);the differences were statistically significant(H=52.31,P<0.05).There were no significant differences in the degree of stiffness and swelling of joint and the presence of noose(P>0.05),but the joint reservation group was better than the joint replacement group in other aspects with statistically significant differences(P<0.05).The Physical Component Summary(PCS)of the SF-36 scores:normal control group(89.06±7.89);joint reservation group(67.40±17.30);prosthesis replacement group(58.00±18.37);the differences were statistically significant(H=29.36,P<0.05).The Mental Component Summary(MCS)of the SF-36 scores:normal control group(91.26±6.20);joint reservation group(74.05±17.20);prosthesis replacement group(73.78±24.04);the difference was statistically significant(H=18.39,P<0.05).There were no significant differences in bodily pain(BP)and mental health(MH)(P>0.05);prosthesis replacement group had higher scores in General Health(GH)and Role-Emotional(RE)than the joint-sparing group,while other dimensions were the opposite with statistically significant differences(P<0.05).Conclusions Compared with tumor curettage and prosthesis reconstruction,the former is better in terms of lower limb function,knee function and quality of life.The application of IKDC and SF-36 scores has reliability for the postoperative evaluation of patients with giant cell tumor of bone.
作者
吴俊杰
于秀淳
徐明
郑凯
崔浩诚
WU Jun-jie;YU Xiu-chun;XU Ming;ZHENG Kai;CUI Hao-cheng(Department of the Orthopedics,the 960th Hospital of PLA Joint Logistics Support Force,Jinan,250031,China)
出处
《中国骨与关节杂志》
CAS
2022年第5期358-365,共8页
Chinese Journal of Bone and Joint
关键词
骨巨细胞瘤
股骨
胫骨
膝关节
生活质量
保留关节保肢术
Giant cell tumor of bone
Femur
Tibia
Knee joint
Quality of life
Joint preservation limb salvage
作者简介
通讯作者:于秀淳,Email:13969132190@163.com。
