摘要
目的分析在新辅助化疗下,采用瘤段骨切除、灭活、再植治疗骨肉瘤的疗效。方法 1995年1月至2010年1月,对47例膝关节周围骨肉瘤患者施行广泛切除,彻底清除瘤组织,95%乙醇浸泡45min瘤段骨灭活,原位回植,修复关节韧带,髓内钉内固定,手术前、后辅助化疗。结果全部病例平均随访34个月,11例因肺转移死亡,4例感染,2例髓内钉折断,局部复发截肢3例,灭活骨骨折、塌陷3例,并发症发生率48.9%。按Enneking肢体肌肉骨骼肿瘤外科治疗重建术后功能评估标准进行评估。本组术后功能评估为优19例(40.4%),良11例(23.4%),中13例(27.7%),差4例(8.5%),优良率达63.8%。结论瘤段骨切除灭活再植手术治疗原发性骨肉瘤,手术简便,花费低廉,无排斥反应,解除了患者因为肢体的缺失带来的心理障碍,是治疗骨肉瘤保肢的有效方法之一,但术后随访证明瘤段骨灭活再植手术,膝关节功能稍差。
Objective To investigate the effect in limb salvage operation on osteosarcoma by alcoholic devitalization after the tumor tissues resection with the help of Neo-adjuvant chemo-therapy. Methods From January 1995 to January 2010,47 cases of osteosarcoma around the knee joint were treated by resecting osteosarcoma region, removing of tumor,immerging the bone stump into a big beaker that contained 95 % alcohol for 45 minutes. Subsequently, the defect was reconstructed with devitalized bone shell in situ,repairing joint ligament,fixing with intramedullary fixation. All patients underwent adjunctive chemotherapy. Results All patients were followed up for an average of 34 mouths. Eleven case＇s died of pulmonary metastasis,4 cases underwent amputation because of local recurrence, 2 case occurred fracture of devitalized bone stump, 3 case underwent subsidence of devitalized bone stump. The rate of complication was 48. 9%. Postoperative functions were estimated according to Enneking system. Among the 47 patients,results in 19（40.4%）were excellent,11（23.4%）were good,13（27.7%）were fair,and 4（8.5%）were poor. The satisfactory rate was 63.8%. Conclusion Reconstruction the defects with devitalized bone stump is an effective method for limb salvage of osteosareoma. It is simple,low cost and no reject reaction. It can remove the psychologic obstacles caused by extremity absence, and is effective for osteosarcoma. But the postoperative follow-up demonsfrated tumor bone devitalization,knee joint function is slightly.
出处
《重庆医学》
CAS
CSCD
北大核心
2012年第29期3059-3060,3063,共3页
Chongqing medicine
关键词
瘤段骨灭活再植保肢手术
膝关节周围
骨肉瘤
alcoholic devitalization limb salvage
around the knee joint
osteosareoma
