保肢手术治疗骨肉瘤的回顾性对照研究

Limb-Sparing Surgical Operation in Treatment of Osteosarcoma:a Retrospective and Control Study

目的：评价不同术式联合化疗治疗骨肉瘤的临床效果。方法：回顾性分析1995—2003年手术治疗的43例骨肉瘤患者的临床资料，其中24例（截肢组）患者行截肢术，19例（保肢组）行保肢手术（18例灭活再植，1例人工假体置换）。术前介入化疗＋放疗、化疗26例，术后单纯化疗17例，37例患者获术后随访时间3．-6年。结果：保肢组发生术后并发症7例（37％），其中骨折4例，感染2例，延迟愈合l例；按Enneking评定标准，优良率为74％（14／19）；3年无瘤生存率、局部复发率、肺部转移率：保肢组分别为42．1、21．1％、42．1％，截肢组分别为38．9％、11．1％、50．0％，两组间比较无显著性差异（P〈0．05）。结论：在手术联合化疗的模式下，保肢术和截肢术可获得类似的疗效，且保肢术可以保留病变部位原有形态及部分功能，但要注意预防术后并发症。

Objective：To evaluate the outcome of different surgical operation options combined with chemotherapy for osteosarcoma. Methods：A retrospective analysis was conducted on clinical data from 43 patients with osteosarcoma undergoing surgical operations from 1995 to 2003. Among them,24 underwent amputation and 19 receive limb-sparing surgery （ 18 patients received devitalized tumor bone reimplantation,one patient prosthetic replacement）. Preoperative interventional chemotherapy and postoperative chemotherapy ＋ radiotherapy were performed in 26 patients and postoperative adjuvant chemotherapy in 17 patients;37 patients were followed up for 3 to 6 years. Results：Of the 19 patients undergoing limb-sparing surgery,7 had postoperative complications （37%） ;4 of these 7 cases had frcture ;2 had infection, 1 patients had delayed union. Functional test showed excellent or good results in 14 out of 19 patients according to Enneking Scoring system. In limb-sparing surgery group, the proportion of patients with 3-year disease-free survival （DFS） was 42.1% ;local recurrence rate was 21.1% ,and lung metastasis rate was 42.1%. In amputation patients, the above parameters were 38.9% , 11.1% ,and 50.0% ,respectively, There was no significant difference between the two groups. Conclusion ：In the combined treatment program, amputation and limb-sparing surgery would lead to a similar clinical outcome. Lim-bsparing surgery could retain the function of lesion sites. Neverthedess,attention should be payed to prevent its complications.