外固定骨延长术在下肢骨肿瘤外科治疗中的应用

External Fixation and Bone Lengthening in the Treatment of Bone Tumor of the Lower Limb

目的探讨下肢骨肿瘤保肢手术的新方法以提高患者的生活质量。方法（１）８例患者中，４例高分化骨肉瘤，手术前后给均予正规化疗；２例骨巨细胞瘤和２例骨母细胞瘤未化疗。（２）所有病例均按Ｅｎｎｅｋｉｎｇ诊断分级标准分级。首先完整切除肿瘤，然后同期应用半环式外固定支架在骨缺损处行加压融合，在胫骨的干骺端截骨处行骨痂缓慢牵伸延长术，重建下肢功能。结果行正规化疗的４例高分化骨肉瘤患者术后存活２９－４８个月，保留肢体功能满意。其余４例对化疗不敏感的病例随访２－７年无复发或转移。所有病例术后１年均可行走，生活自理。１例已参加农业劳动。结论（１）对化疗敏感的病例，必须实行大剂量化疗，为手术和延长生命创造条件。（２）在彻底完整地切除肿瘤后用一个外固定架同期行肢体延长术，保留了组织结构，矫正了肢体短缩畸形，恢复了徒步行走功能。具有改善心理、生理状态，提高生活质量的积极意义。（３）该方法不失为一种有实用价值的骨肿瘤保肢治疗新技术。

Objective To study the effect of external fixation and bone lengthening in the treatment of bone tumors of the lower limb. Methods Eight patients with bone tumors of the lower extrimeties were included in this study. There were 4 with osteosarcoma, 2 with giant cell tumor of the bone and 2 osteoblastoma, neoadjuvant chemotherapy was given to the patients with osteosarcoma. All of the bone tumors were treated by en bloc resection and semicircular external fixator to lengthen the limb at metaphysis. Results Four cases of well differentiated osteosarcoma given standard chemotherapy and followed up for 29 to 48 months had satisfactory limb function. The other 4 cases were followed up for 2 to 7 years and no recurrence or metastasis occurred. All of the survived patients were ambulatory 1 year after the operation and could look after themselves, and one patient could do farm work. Conclusion All of the malignant bone tumors should be given large dosage chemotherapy. Following en bloc resection of the tumor, external fixator can help to reconstruct the bone defect and restore the limb function. This method is valuable for the treatment of lower limb bone tumors in the well selected cases.