四肢恶性骨肿瘤截除并保留肢体方法的探讨(附62例分析)

Limb Conservancy in Malignant Bone Tumors of Extremitries: with An Analysis of 62 Cases

报道1984年5月～1988年4月采用肿瘤段截除术并保留肢体的方法、结合术前术后大剂量氨甲喋呤并用甲酰四氢叶酸钙解毒及阿霉素,治疗62例四肢恶性骨肿瘤患者,经随访10～58个月,除6例术后8～12个月局部软组织复发再作切除,且术中未见骨质受累外,其余大部分病例均获较好疗效。62例中,有8例术后1～3年死于肺转移,其中6例有广泛软组织浸润和严重的骨质破坏而行再截肢术。

Since. May 1984 to April 1988,referring to Rosen's plan and combining with the concrete condition of our hospital, large doses of Methotrexate,calcium formyltetrahydrofolate antidote and adriamycin were adopted preand post-opcratively in treating of 62 cases of malignant bone tumors of extremities by segmental resections of their bone tumors and their limbs were preserved with good result. The segmental resections of the bone tumor should be performed after taking 1-2 doses of the chemotherapeutic drugs.And the chemotherapy should be continued post-operatively with gradual increasing of their dosages. Generally, altogether 8-10 doses were necessary in the whole course of treatment. All cases were followed-up for 10-58 months, most of them showed good results except 6 cases recurred in the local soft tissues 8-12 months postoperatively. Local resections were performed, again, but no bony infiltration had been found locally during the 2nd operation. In the 62 cases, there were 8 cases died of metastasis of lung 1-3 years after operation, among them, 6 cases showed extensive soft tissue infiltration and serious bony destruction during operation, and reamputation had to be done. The author indicated that (l)ought to control strictly the operative indi- cations. Early and less malignant bone tumors possess satisfactory results; (2) concerted use of large doses of chemotherapy should be made for limb conservancy; (3) it would be best to avoid preoperative biopsy in order to avoid extensive infiltration of the surrounding soft tissue to affect healing and prognosis; (4)95% alcohol is used not only to inactivate the superficial tumor cells on the isolated, segment, but also to produce high temperature about 50℃ inside the bone cementum, due to hypoxia, to support the inactivation; (5)this plastic prosthesis is much better than the metallic ones or allogeneic joint transplantation because this method is convenient, time and money saving,retaining of the anatomical intactness, etc.It possesses some definite immune mechanism as well.