摘要
目的 评价保肢术结合辅助化疗治疗肢体Ⅱ B期骨肉瘤的临床疗效。方法 选择 1989年 6月～ 1996年 6月保肢手术结合辅助化疗治疗肢体Ⅱ B期骨肉瘤患者 35例，男 25例，女 10例；年龄 15～ 36岁，平均 20.34岁。发病部位 :股骨下端 22例，胫骨上端 7例，肱骨上端 3例，腓骨上端 2例和股骨上端 1例。 35例中达到广泛切除 20例，而仅达边缘切除 15例。 3例肱骨上端病例行 Tikhoff－ Linberg手术； 2例腓骨上端病例仅做肿瘤切除术；其余 30例病例分别采用瘤骨灭活再植 17例，异体半关节移植 9例和人工假体置换 4例。 31例接受过术前化疗的病例切除标本均做多病理切片的坏死率评估，所有病例接受 3～ 10年 (平均 5年 8个月 )的随访。结果 35例患者 3年无瘤生存 24例 (68.6％ )；无瘤生存超过 5年共有 13例 (生存可能率为 60.4％ )。 31例接受过术前化疗病例的肿瘤细胞坏死率大于 90％者 28例 (90.3％ )。发生并发症 14例 (40.0％ )，其中感染 3例 (8.6％ )，植入骨骨折 7例 (20.0％ )，骨不愈合 1例 (2.9％ )，肿瘤局部复发 3例（ 8.6％）。因并发症而行再次手术共 15例次（ 43.0％），其中截肢 6例 (17.0％ )。肢体功能评估优良率为 68.6％。统计学处理显示肿瘤坏死率与无瘤生存率之间无显著相关性 (rs=0.090?
Objective To evaluate the clinical effectiveness of limb salvage surgery combined with adjuvant chemotherapy for the stageⅡ B extremity osteosarcoma. Methods Between June 1989 and June 1996, 35 patients aging from 15 to 36 years(average 20.34 years) with the diagnosis of stageⅡ B extremity osteosarcoma were treated with combined adjuvant chemotherapy and limb salvage surgery. The tumors were located at the distal end of femur in twenty two patients, the proximal tibia in seven, the proximal humerus in three, the proximal fibula in two and proximal femur in one. The histological evaluation of surgical margins revealed wide resection in 20 patients and marginal resection in 15 patients. Various reconstructive methods were used to re establish proper length structural support of the extremities after the massive resection of the tumors. Among them, devitalized tumor bone reimplantation was done in 17 cases, osteoarticular allografts implantation in 9 patients and endoprosthestic replacements in 4 patients, while Tikhoff－ Linberg surgery in 3 cases with the proximal humerus lesions and simple tumor resections in 2 patients with fibula lesions. Multiple histological sections were examined from each of the resected specimens in 31 patients who received preoperative chemotherapy to determine the effect of the chemotherapeutic agents. The patients have been followed up for 3 to 9 years (mean 5 years and 8 months). Results Major surgical complications occurred in 14/35 cases (40％ ). As the results of these complications, revised operations were performed in 14 patients, of whom, 6 cases had amputation. Tumors from 31 patients treated with preoperative chemotherapy, were evaluated for histological response following completion of induction therapy. Twenty eight cases (90.3％ ) were regarded as a good response with the chemotherapy induced tumor necrosis rate > 90％ ; another 3 cases as a poor response with the tumor necrosis rate≤ 90％ . Of the 35 cases, 24 (68.6％ ) belonged to disease free survival (DFS) at 3 years after surgery, and DFS probability at 5 years was 60.4％ . The evaluated functional results revealed an excellent or good result in 60％ of the patients. Correlation analysis revealed that the DFS probability was not related to the rates of the tumor necrosis (rs=0.090； P=0.635), while the local recurrence of tumor were significantly related to the tumor necrosis（ rs=－ 0.433； P=0.017） , but not to the surgical margin（ rs=0.068； P=0.721） . The rates of complications were not related to the reconstuctive methods (rs=－ 0.268; P=0.119). Age, sex of the patients, site and subtype of the tumors were not significantly prognostic variables. Conclusion The limb salvage surgery combined with adjuvant chemotherapy is an ideal treatment method for the extremity osteosarcomas. An effective preoperative chemotherapy combined with extirpative surgery make limb salvage surgery successful. However, limb salvage procedures result in high rate of complications. Further study must be conducted to reduce local recurrence and improve reconstructive methods.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2000年第7期393-399,共7页
Chinese Journal of Orthopaedics
关键词
肢体ⅡB期骨肉瘤
保肢手术
辅助化疗
Osteosarcoma
Chemotherapy,adjuvant
Extremities
Salvage therapy
Treatment outcome
