保留皮质的扩大切除与重建术治疗四肢侵袭性骨肿瘤

Treatment of the extremities invasion bone tumor with reservation cortical expand resection and reconstruction

[目的]探讨保留皮质的扩大切除与重建术的临床应用及疗效。[方法]12例侵袭性骨肿瘤患者男6例,女6例;平均年龄37.1岁。根据MRI表现选择不同截骨方法,Ⅰ型肿瘤位于干骺端偏心性生长,采用保留一侧皮质骨的肿瘤外截骨,截骨线呈"匚"形。Ⅱ型病例肿瘤侵蚀部分关节面,采用保留一侧皮质的部分关节截骨,截骨线呈"L"形。Ⅲ型病例肿瘤侵蚀整个关节面和骨皮质,可切除包括关节在内的整个瘤段骨,只是近骨干侧截骨呈阶梯状。[结果]手术时间1～3h,术中出血量150～400ml,术后切口一期愈合。12例患者获6个月～8年随访。按ISOLS评分标准评价肢体功能恢复情况:上肢平均22.3分,下肢平均25.3分。灭活回植骨、异体骨与截骨端平均3个月愈合,局部复发1例,复发率7.69%。无恶性变及全身转移。[结论]保留皮质的扩大切除与重建术可提高四肢侵袭性骨肿瘤的治疗效果;严格掌握适应证、无瘤无菌操作、彻底灭活瘤壳和截骨端是降低复发率的关键。

[ Objective] To investigate the clinical application and therapeutic effect of reservation cortical expand resection and reconstruction for extremities bone tumor. [ Method ] Twelve cases with extremities invasion bone tumor were reviewed, including 6 male and 6 female. The average age was 37. 1 years old. According to the MRI, Type I tumor located in metaphysic and growth eccentricity, and was treated with outside tumor osteotomy with reservation of one side as integumentale, the cut line was shape of ＂匚＂. Type Ⅱ tumor was with invasion part articular surface, and was operated with part joint osteotonly with reservation of one side as integumentale, the cut line was shape of ＂L＂ . Type Ⅲ was with invasion total joint surface and as integmentale, all tumor segment including joint could be cut, but the shape of cut close to the diaphysis was echelonment. [ Result] The operation time was 1 -3 h, the operative bleeding quantity were 150 ～ 400 ml, all incisions were obtained primary healing. Twelve cases were followed up from 6 months to 8 years. The average extremity functional score according to the system of ISOLS （ International Society of Limb Salvage） ： upper extremity was 22.3 and the lower was 25.3 The average bone healing time of returned deactivation bone graft and bone allograft healing with the osteotomy plane was 3 months, original tumor recurrence in local was 1, the recurrence rate was 7. 69% , no malignant change and metabasis was found. [ Conclusion] The reservation cortical expand resection and reconstruction could increase the treatment effect of extremities bone tumor, it is key to decrease the recurrence with strict indication, non-neoplasma and aseptic technique. Tumor shell and osteotomy plane should be deactivated thoroughly.