【摘要】 背景与目的:恶性骨肿瘤发病率较低,仅占人类全部恶性肿瘤的1%左右,临床中出现误诊误治的现象很多。本研究在分析21例肢体骨恶性肿瘤首诊失误原因的基础上,探讨挽救治疗的方法及其疗效。方法:回顾性分析我院1998年10月—2005年12月间收治的21例首次诊疗失误的肢体骨恶性肿瘤患者的临床资料及平均随访22个月(6~67个月)的随访结果。其中骨巨细胞瘤(GCT)3例,骨肉瘤12例,尤文氏肉瘤1例,恶性纤维组织细胞瘤3例,骨纤维肉瘤1例,恶性骨母细胞瘤1例。21例中,2例误诊为“骨囊肿”行病灶刮除植骨;19例误诊为“骨髓炎”行病灶刮除,3例加用灌洗引流。结果:11例保留肢体的患者,按Enneking的骨肿瘤外科治疗后功能评定标准,优良率72.7%(8/11)。广泛性截肢10例,11例保肢后再截肢5例,除GCT外均辅以化疗。死亡8例(38.1%),存活13例(占61.9%),其中4例为带瘤存活。结论:恶性骨肿瘤的诊治要强调首次诊疗的正确性及规范性,建立完善的转诊制度是减少治疗失误的有效途径。对于首次诊疗失误的患者,推荐以手术及化疗为主的综合治疗,慎用保肢术。更多还原

【Abstract】 Background and purpose:Malignant bone tumor has a low morbidity, which accounts for about 1% in all malignant tumors,but there are many misdiagnoses in clinical treatment. In this study, we analyzed the causes of misdiagnosis of malignant bone tumor of limb and the influence on therapy. Methods:Twenty-one patients who had been admitted to our hospital from October 1998 to December 2005 and who had been misdiagnosed at first diagnosis were reviewed, , including 3 case with giant cell tumor of the bone, 12 cases with osteosarcoma, 1 case with Ewing’s sarcoma, 3 cases with malignant fibrous histocytoma, 1 case with fibrous sarcoma and 1 case with malignant osteoblastoma, of them 2 were misdiagnosis as bone cyst, 19 as chronic osteomyelitis.Results:Mean follow-up time was 22months(6-67 months). 10 cases accepted amputation; 5 accepted amputation for infection or tumor recurrence of 11 cases accepted limb salvage. Of them 8 died, 13 survival but 4 with tumor. The function of the affected limb was 72.7%(8/11), considered to be high.Conclusions:We emphasize correctness and standardization of the first treatment of malignant bone tumor, timely transfer at diagnosis is an effective way to reduce mistakes. We recommend combined treatment by means of operation for these patients, and prudent use limb-salvage.更多还原