骨腫瘤病患接受訂製型全人工膝關節置換手術後之生活品質

Quality of Life of Bone Tumor Patients after Custom-made Total Knee Arthroplasty

目的：了解（1）骨腫瘤病患接受腫瘤廣泛切除，且以訂製型全人工膝關節置換重建術後之生活品質；（2）切除部位不同（股骨遠端或脛骨近端）之病患，生活品質是否有差異。方法：受試者25名（男13名，女12名，平均21.5±7.0歲；股骨遠端者15位，脛骨近端者10位），均為接受腫瘤廣泛切除，且使用訂製型全人工膝關節置換手術一年以上，並已完成化學治療之骨腫瘤患者。以Musculoskeletaal Tumor Society 功能量表評估病患之下肢功能，滿分為30分；FORTC-C30（European Organization for Research and Treatment of Cancer）問卷評估病患之生活品質，各範疇以100分為滿分。結果：病患下肢功能平均得分為21.2±2.9分。生活品質方面，整體性健康相關生活品質67.0±20.5分；功能評估中以認知功能（94.0±9.5分）最好，生理功能（68.8±22.4分）最差；症狀評估得分低者較好，其中以食慾（4.0±11.1分）及睡眠（4.0±14.7分）最佳，疲乏（23.1±12.8分）最影響病患。不同部位腫瘤的兩組病患不論在功能、症狀評估及下肢功能均無顯著差異（p>0.05）。結論：病患之下肢功能約為正常之70.7%，且接受切除腫瘤部位不同之兩組病患，其下肢功能與生活品質並無顯著差異。

Purposes: This study was designed to investigate the quality of life in bone tumor patients after they underwent wide resection of tumor followed by reconstruction with custom-made total knee replacement, and if there was any difference in quality of life between patients with different lesion sites (distal femur or proximal tibia). Methods: The subjects were twenty-five bone tumor patients (13 males and 12 females, mean age was 21.5±7.0 years old, 15 in distal femur and 10 in proximal tibia) who underwent wide resection of tumor and reconstruction with custom-made total knee replacement for at least one year and completed the course of post-operative chemotherapy. Functions of lower limbs were assessed with functional assessment system developed by Musculoskeletal Tumor Society (maximal score 30 points). The quality of life was assessed with EORTC-C30 (European Organization for Research and Treatment of Cancer), which is a 30-item questionnaire. All scales are linearly transformed to a scale of 0 to 100. Results: the mean± SD score of function of lower limbs was 21.2±2.9. Results of EORTC-C30 showed the global health and quality of life was 67.0±20.5. Among the functional scales, cognitive function was the best with a mean± SD of 94.0±9.5, whereas physical function was the worst with a mean± SD of 68.8±22.4. A lower score in symptom scales represents milder level of symptoms. Among the symptom scales, the sleep and appetite were least affected with means± SD of 4.0±14.7 and 4.0±11.1 respectively, on the other hand , the fatigue was the most important complaint with a mean± SD of 23.1±12.8. There was no significant difference in functional scales, symptom scales and the function of lower limbs between the two groups with different lesion sites (p＞0.05). Conclusion: The overall function of lower limbs in bone tumor patients was 70.7﹪of normal function. There was no significant difference in lower limb function and quality of life between the two groups.