足部骨肿瘤治疗结果的回顾性分析

Retrospective analysis of treatment results for bone tumor in the foot

目的探讨足部骨肿瘤的发病特点,提高足部肿瘤的诊治水平。方法回顾分析2000年3月-2009年4月收治的足踝部骨肿瘤32例,男18例,女14例。平均年龄36岁(13～61岁)。其中Ewing肉瘤2例,恶性纤维组织细胞瘤1例,软骨肉瘤3例,转移瘤1例,骨巨细胞瘤2例,软骨母细胞瘤3例,骨囊肿7例,骨样骨瘤2例,内生软骨瘤6例,骨软骨瘤1例,动脉瘤样骨囊肿4例。骨囊肿治疗方法采取透视下经皮注射生物蛋白胶及激素治疗;骨样骨瘤采用CT引导下经皮穿刺微波热疗术;其他良性肿瘤采用常规刮除植骨术。恶性肿瘤采用联合治疗方法,包括术前化放疗、术中磨钻及蒸馏水浸泡、术后放化疗等。结果 1例恶性纤维组织细胞肉瘤术后10个月复发行小腿截肢术,术后12个月死亡。2例Ewing肉瘤术后因转移死亡。感染1例,伤口换药8个月愈合。因异体骨排斥渗液伤口延迟愈合1例,术后9个月痊愈。余29例随访1-59个月(平均19.3个月),长期无瘤生存。结论随着微创概念的引进及新辅助化疗的不断进展,经皮注射生物蛋白胶和激素、经皮微波热疗术在足部骨肿瘤中的应用已经取得初步成果,创伤小,恢复快;各种物理治疗如磨钻、60°蒸馏水等的术中应用可降低复发率。

Objective To investigate the pathogenetic features of bone tumor in the foot, and to improve its diagnosis level. Methods From March 2000 to April 2009, a total of 32 patients （18 males, 14 females） with bone tumor in the foot treated in our hospital were retrospectively analysed. The mean age was 36 （range, 13-61）. 2 cases were with Ewing sarcoma, 1 with malignant fibrous histiocytoma, 3 with chondrosarcoma, 1 with metastatic tumor, 2 with osteoclastoma, 3 with chondroblastoma, 7 with bone cyst, 2 with osteoid osteoma, 6 with enchodroma, l with osteochondroma, and 4 with aneurysmal bone cyst. Percutaneous injection of fibrin glue and hormonotherapy under fluoroscopic control were performed in tbe treatment of bone cyst. Percutaneous puncture microwave thermotherapy with CT guidance was performed in the treatment of osteoid osteoma, and routine curettage and grafting were performed in the treatment of other benign tumors, In the treatment of malignant tumors, combined treatment methods were applied, including pre-operative chemotherapy and radiotherapy, intra-operative abrasive drilling and distilled water soaking, and post-operative radiotherapy. Results 1 case with malignant fibrous histiocytoma underwent leg amputation due to post-operative recurrence and died 12 months after the amputation. 2 cases with Ewing sarcoma died of metastasis post-operatively. 1 case reported infection and healed in 8 months post-operatively through dressing change. 1 case reported delayed healing because of allograft rejection and seepage, who healed in 9 months post-operatively. The other 29 cases survived without tumors, with a mean follow-up being 19.3 months （range, 1-59 months）. Conclusions With the introduction of minimally invasive technique and the consistent development of neo-adjuvant chemotherapy, the percutaneous injection of fibrin glue and hormonotherapy and the ercutaneous puncture microwave thermotherapy have shown preliminary achievements in the treatment of bone tumor in the foot. These treatment methods have the advantages of a smaller incision and shorter healing period. The recurrence can be reduced through intra-operative physiotherapy such as abrasive drilling and 60 degrees distilled water soaking.