肢体恶性骨肿瘤及骨转移癌保肢治疗

Limb salvage treatment for malignant bone tumor or metastasis bone tumor of extremities

目的：探讨肢体恶性骨肿瘤及转移癌行瘤段切除假体重建的方法及意义.方法：本组共62例,男38例,女24例;年龄10～72岁,平均28.4岁.原发肢体恶性骨肿瘤41例,其中骨肉瘤19例,骨巨细胞瘤9例,恶性纤维组织细胞瘤8例,浆细胞瘤3例,尤文氏瘤1例,骨血管内皮瘤1例.骨转移癌21例,原发病灶分别为：肺癌9例,胃癌3例,肾癌2例,乳腺癌2例,甲状腺癌1例,颌下腺癌1例,原发灶不明者3例.对62例肢体恶性骨肿瘤及转移癌应用肿瘤段切除并修复重建治疗.方法有：①瘤段切除人工假体置换术;②瘤段切除自体腓骨移植术;③瘤段切除髓内针骨水泥重建术.结果：术后随访5～42个月,平均14.2个月,41例恶性骨肿瘤中,术后无瘤生存21例,死亡4例,7例发生肺转移,3例发生其他部位转移,6例局部复发后截肢.37例生存患者患肢功能按Enneking骨肿瘤外科治疗后功能评定标准,优良率81.1%.21例骨转移瘤患者中,术后存活3个月以上者19例（占90.4%）;术后疼痛消失15例（占71.4%）,其余均有疼痛减轻;日常生活工作恢复者11例（占52.3%）.结论：对可施行广泛切除的肢体恶性骨肿瘤患者采用不同方法修复重建,行保肢治疗,可在治疗肿瘤的前提下尽量保留肢体功能,对肢体骨转移癌行合适的保肢手术对提高骨转移癌患者的生存质量有积极意义.

Objective：To explore treating methods and to study therapeutic effects of limb salvage surgery in the patients with malignant bone tumor or metastasis bone tumor of extremities. Methods：From 1999. 12 to 2004 11,62 patients （ male 38, female 24, ranging in age from 10 to 72 years, meanly 28. 4 years ） with malignant bone tumor or metastasis bone tumor of extremities（41 cases were primary and 21 cases were metastasis ） were treated with wide margin resection and reconstruction. The treating methods were as follows. ①prosthetic replacement following tumor resection;②seff-grafting of fibula after tumor resection ;③intramedullary nail with bone cement reconstruction after tumor resection. Forty-one patients were malignant bone tumor, among which 19 patients were osteogenic sarcoma ,9 patients were giant cell tumor of bone ,8 patients were malignant fibrous histioeytoma,3 patiens were plasma cell tumor, 1 patient was Ewing＇s tumor, and 1 patient was hemangioendothe lioma of bone. Other 21 patients were metastatic bone tumor with the primary carcinomata in other organs, inclu- ding lung cancer in 9 patients, stomach cancer in 3 patients, renal carcinoma in 2 patients, mammary cancer in 2 patients, thyroid cancer in 1 patient, carcinoma of submaxilary gland in 1 patient, and not definite in 3 patients. Results.All the patients were followed up from 5 to 42 months,with an average of 14. 2 months. Among 41 patients with primary malignant bone tumor, 21 patients were survived without recurrence, 4 patients died, 7 pa- tients had metastasized tumor to lung,3 patients had metastasized tumor to other organs, and 6 patients underwent amputation due to local recurrence. According to Enneking＇s standard, the function of affected limb was evaluated in 37 survival patients ,and the excellent and good rate was 81.1%. Among 21 patients with metastasis tumor, 19 patients （90. 4% ） could live more than 3 months, 15 patients （71.4%） had pain disappeared （ other patients had pain relieved after operation）,and 11 patients（52. 3% ） recovered to normal daily life. Conclusion ：Limb salvage treatment method combined with different reconstruction for patients with malignant bone tumor of extremities suitable to be done wide rescetion is effective to maintain limb function as more as possible ; and if this method is used to patients with metastasis bone tumor of extremities, the living quality of patients can be improved.