【摘要】 目的 探讨肢体恶性骨肿瘤保肢手术结合辅助化疗的临床疗效。方法 我科于2000年1月至2002年10月间,对平均年龄为18.5岁的29例四肢恶性骨肿瘤患者进行保肢治疗,其中25例进行了辅助性化疗。29例中,骨肉瘤21例,尤文氏瘤4例,软骨肉瘤4例,按Enneking分期,ⅡA期1例,ⅡB期28例。除软骨肉瘤外,均作术前化疗,3例骨肉瘤未作术后化疗。施行人工关节置换术14例,瘤骨灭活再植10例,异体骨关节移植3例,腓骨肿瘤切除2例。广泛切除15例,边缘性切除14例。结果 发生并发症8例,其中局部复发、皮肤坏死、骨不愈合各2例,皮下积液、切口感染各1例。随访4～31个月,平均14个月,局部复发2例,肺转移2例,按Enneking肢体肌肉骨骼系统肿瘤外科治疗重建术后功能评定标准,优良率为80％。结论 保肢手术结合辅助化疗是治疗肢体恶性骨肿瘤的比较理想的方法,有效的术前化疗是保肢成功的关键,坚持术后化疗是预防肺转移的有效措施。更多还原

【Abstract】 Objective To evaluate the clinical effectiveness of limb salvage surgery combined with adjuvantchemotherapy for malignant bone tumor of the extremity. Methods Between Jan. 2000 and Oct. 2002, 29 patients agingfrom 11 to 42 years(average 18.5 years) with the diagnosis of malignant bone tumor of the extremity were treated withadjuvant chemotherapy and limb salvage surgery. There were 21 osteosarcoma,4 Ewing’s tumors,4 chondrosarcomas. Thestages of tumors according to Enneking classification were Ⅱ A in 1, ⅡB in 28. Among them, endoprosthestic replace-ments was done in 14 patients, devitalized tumor bone reimplantation in 10 patients and osteoarticular allografts implanta-tion in 3 patients, simple tumor resection was performed in 2 patients with fibula lesions. The histological evaluation ofsurgical margins revealed wide resection in 15 patients and marginal resection in 14 patients. Results Major surgicalcomplications occurred in 8 cases(27. 6 %). Local recurrence in 2 cases, skin necrosis 2 cases, subcutaneous hydrops in1 cases, infection 1 cases, nonunion 2 cases and one of them breakage of internal fixation. The patients were follow - upfrom 4 to 31 months (average 14 months). Lung metastasis occurred in 2 cases. The patients were evaluated in regard tofunction with use of Enneking system. 6 cases had excellent results, 14 cases good,three cases fair, 2 cases poor, an ex-cellent or good result in 80% of the patients. Conclusion The limb salvage surgery combined with adjuvantchemotherapy is an ideal treatment method for malignant bone tumor, an effective preoperative chemotherapy combinedwith extirpative surgery make limbs salvage surgery successful, the postoperative chemotherapy is the only method of pre-ventive lung metastasis.更多还原