新辅助化疗联合人工膝关节置换治疗膝关节附近骨肉瘤

The New Adjuvant Chemotherapy Combined with Total Knee Arthroplasty for Treatment of Osteosarcoma Nearby the Knee

目的:评价新辅助化疗联合人工膝关节置换治疗膝关节附近骨肉瘤的临床疗效。方法:38例膝关节附近骨肉瘤采用新辅助化疗和人工膝关节置换,所有病例均进行肿瘤细胞坏死率、5年内肿瘤局部复发率、5年生存率和膝关节功能评估。结果:38例患者新辅助化疗后肿瘤细胞坏死率平均95.8%;随访6-9年,38例患者中5年内肿瘤局部复发12例(31.6%),5年后生存31例(81.6%),膝关节功能优良率92.1%。结论:新辅助化疗联合人工膝关节置换治疗膝关节附近骨肉瘤可有效提高骨肉瘤5年生存率,保存患肢功能,是骨肉瘤保肢治疗的一种较好的方法。

Objective： To evaluate the clinical therapeutic effect of new adjuvant chemotherapy combined with total knee arthroplasty （TKA） for treatment of osteosarcoma nearby the knee. Methods： A total of 38 patients （26 males and 12 females, aged 15-24 years ）with osteosarcoma were treated by new adjuvant chemotherapy combined with TKA. And multiple histological sections were examined from each of the resected specimens to determine the effect of the chemotherapeutic agents. During the follow- up period, the lo- cal recurrence and 5-year survival rate were investigated and the function of artificial joint was evaluated. Results： All the patients were followed up for 6 to 9 years. Among the 38 patients,after the new adjuvant chemotherapy, the tumor cell necrosis rate was 80.7%-98.4% （mean is 95.8% ）; local recurrence rate within 5 years 31.6% （12 cases） and survival rate after 5 years was 81.6% （31 cases）; the functional good rate was 92.1%. Conclusions： The new adjuvant chemotherapy combined with TKA not only achieves a good survival but also an excellent functional of knee, thus it is a good alternative for osteosarcoma nearby the knee.