恶性骨肿瘤的保肢治疗

The Limb Salvage Methods of Patients with Limb Malignant Tumor

目的探讨不同的重建方法在四肢恶性骨肿瘤保肢中的应用价值。方法分析比较356例恶性骨肿瘤患者分别进行各种保肢术后的效果、生存质量、并发症及处理。本组患者均采用新辅助化疗即:术前化疗+手术+术后化疗。在肿瘤切除后,采用人工关节置换185例,大段异体骨移植82例,骨水泥填充22例,灭活再植17例,自体腓骨移植13例,单纯切除无重建者37例。结果356例恶性骨肿瘤患者术后出现远处转移的共42例,均为肺部转移,其中2例合并肋骨转移,局部复发42例,远处转移和局部复发共84例,占23.6%。最终保肢率占77.4%。结论在恶性骨肿瘤保肢手术中,肿瘤广泛切除后,骨重建技术的进步,是增加保肢手术范围,改善功能效果,降低手术并发症的关键。

Objective To study different reconstruction methods value in patients with limb malignant bone tumor. Methods 356 patients with limb malignant bone tumor were operated with different LIMS limb salvage methods. Analysize and compare with the effect, survive qulification and complication. All of 356 patients were treatd with new auxiliary chemical treatment（ chemical treatment before operation ＋ operation ＋ chemical treatment after operation）. There were 82 tumor treated with massive bone allograft, 185 tumor with arthroplasty. 17 tumor killing and regraft. 22 tumor with cementing, 13 tumor with fibular autograft. 37 cases simple resection without reconstruction. Results Among 356 cases, there were 42 tumor with distance transplant, 42 tumor local recurrence, 84 tumor distance transplant and local recurrence. The rate was 23.6% o 77.4% of 356 patients were succeed. Conclusion Improving of bone reconstruction technology in patients with limb malignant tumor is the key which increases the reserving scope, improves the effect, declines the complication.