组织修复及功能重建在四肢恶性骨肿瘤保肢治疗中的临床应用探讨

Clinical Application of Tissue Repairing and Functional Reconstruction in Limb Salvage Treatment of Bone Malignant Tumor

目的探讨恶性骨肿瘤切除后,采用同种异体骨移植和自体瘤段骨灭活再植进行保肢治疗的过程中组织修复及功能重建的重要性。方法回顾性分析我院收治59例恶性骨肿瘤的患者,其中男35例,女21例。成骨肉瘤32例,软骨肉瘤17例,恶性骨巨细胞瘤3例,转移瘤4例。位于肱骨近段者9例,股骨远端30例,胫骨近段17例。结果本组优20例(35.7%),良11例(19.6%),可8例(14.3%),差17例(30%),治疗满意率70%.56例中无瘤存活38例,死亡12例,5年生存30例,5年生存率55%.其中51例随访时间超过10个月,均骨性愈合,无骨不连。除局部肿瘤复发以外,常见并发症有感染4例,骨折3例,关节面塌陷1例,关节强直5例,感染率仅7%,无内固定折断。结论采用同种异体骨移植和自体瘤段骨灭活再植对四肢恶性骨肿瘤行有效的组织修复和功能重建,不但可以保留肢体,且保留的肢体具有良好的功能,为四肢骨骼系统恶性肿瘤患者开辟了有效的治疗途径。

Objective To discuss the significance of tissue repairing and functional reconstruction in treatment of extremity malignant tumor against amputation by adopting allogeneic bone graft and replanting devitalized bone after malignant bone tumor resection.Methods Fifty-nine cases with malignant bone tumor were analysed retrospectively,including 35 male patients and 21 female patients.The age is between 9 and 60 years old,the average is 19.The location of nine cases,tumor was on proximal hunerus,30 cases on distal femur and 17 cases on proximal cnemis.Thirty-two cases were osteogenic sarcoma,17 cases were chondroma sarcomatosum,3 cases were maligant giant cell tumor of bone and 4 cases were metastatic.Results Among these 59 patients,the effect of 20 patients（35.7%） were excellent,11 patients（19.6%） were good,8 patients（14.3%） were fair and 17 patients（30%） were poor.The satisfactory rate was 70%.Thirty-eight patients survived for tow years without tumor.The five survival rate was 55 percent.Except locally relapsed,the main complications were infection（4 cases）,fracture（3 cases）,collapse of articular facet（1 cases）and arthrocleisis（5 cases）.The infection rate was only 7%.No internal fixation was broken.Conclusion For extremity malignant tumor,effective tissue repairing and functional reconstruction can not only reserve extremity,but also afford it fine function,and it supplies one effective method for bone malignant tumor.