転移性大腿骨骨幹部骨腫瘍に対する人工骨幹置換の有用性

Usefulness of Endoprosthetic Reconstruction for Patients with Metastatic Tumors of the Femoral Diaphysis

目的：大腿骨幹部に発生した転移性骨腫瘍に対する治療方法として大腿人工骨幹(K-MAX. Japan Medical Materials)を用いる再建法の有用性について検討した．対象・結果：症例は7例(男性3例，女性4例)，年齢は平均67歳，手術は大腿骨幹部骨腫瘍を骨幹部の腫瘍のみ切除後に人工骨幹で再建した．術後小脳転移で歩行できなかった1例を除いたMusculoskeletal Tumor Society(MSTS) scoreは79％であった．転帰はdead of disease 3例，alive with disease 3例，no evidence of disease 1例，経過観察中に4例は独歩，2例は杖歩行が可能となった．結語：大腿骨幹部に生じた悪性骨腫瘍に対する本法は，術後早期に荷重が可能であり，局所コントロールに優れ，予後予測が長い場合には有用である．

　Improvement of the life expectancy of patients with long-bone metastases has increased the emphasis on preserving the function of the affected limb.　Between 2006 and 2009, we used custom-made endoprostheses to reconstruct femoral diaphyseal defects in seven patients after excision of femoral metastases.　The mean postoperative score for the affected limb according to the function scoring system of the Musculoskeletal Tumor Society (MSTS) score was 79% (exclusive of one patient who died soon after surgery).　No local recurrences or mechanical loosening have developed.　We concluded that diaphyseal endoprosthesis of the femur yields a good clinical and functional outcome.