14例四肢孤立性骨转移癌1期整块切除保肢重建的疗效

Efficacy of En Bloc Resection,Limb Salvage,and Reconstruction on Solitary Stage I Bone Metastatic Carcinoma:A Follow-up Report of 14 Cases

目的：探讨四肢孤立性骨转移癌1期整块切除保肢重建后疗效，对患者手术前后疼痛减轻、生活质量改善及肢体功能进行评价。方法：2006年9月至2010年6月上海交通大学附属第六人民医院骨科收治四肢孤立性骨转移癌为首发临床表现病例14例，同期发现原发病灶。术前及术后1个月进行疼痛评分。疼痛评分采用数字0～10评分法。术前及术后3个月给予生活质量评分，采用SF-36评分系统。术后3个月参照MSTS评分系统进行肢体功能评分。结果：患者术前疼痛评分为（8．14±1．29）分，术后1个月疼痛评分为（1．50±0．65）分，术后疼痛症状明显改善（t=21．600，P〈0．001）。术前生活质量平均为34．93±11．75，术后3个月生活质量平均为（65．00±10．81）分，术后患者生活质量明显改善（t=-15．479，P〈0．001）。术后MSTS评分范围18～27分，平均（22．43±2．38）分。广泛切除和边缘切除的无瘤生存期经Logrank检验分析，二者之间差异无统计学意义（x2=2．931，P=0．087）。结论：四肢孤立性骨转移癌为首发表现患者，1期切除原发病灶，同时按原发骨肿瘤原则行瘤段广泛或边缘整块切除保肢治疗，术后可以明显减轻患者疼痛，提高患者生活质量，改善肢体功能。

Objective： This study aims to evaluate the therapeutic effects of en bloc resection and limb salvage reconstruction on patients with solitary stage I bone metastatic carcinoma, including pain relief, quality of life, and limb ftmctions. Methods： A retrospective treatment outcome review was performed on 14 patients with solitary bone metastasis as the primary clinical symptom who were admitted to the Department of Orthopedics, The Sixth People＇s Hospital of Shanghai Jiaotong University, China between 2006 and 2010. The primary diseases were diagnosed subsequently. Pain scoring was assessed before and one month after surgery. Pain assessment was conducted using the 0 to 10 numerical rating scale. The quality of life scoring was performed before and three months after surgery using the SF-30 scoring system. In addition, limb function was assessed three months after the operation using the Scoring System of American Musculoskeletal Tumor Society system （MSTS）. Results： The mean preoperative pain score was 8.14±1.29, whereas the postoperative pain score was 1.50±0.65. The symptom was significantly ameliorated after the operation （t = 21.600, P〈0.001）. The mean preoperative quality of life score was 34.93 ± 11.75, whereas the mean postoperative score was 65.00 ±10.81. Therefore, the quality of life dramatically improved （t = -15.479, P〈 0.001）. The postoperative MSTS scores ranged from 18 to 27. The average score was 22.43 ± 2.38. The log rank test showed that no significant differences （X2 =2.931, P=0.087） were observed in the tumor-free survival time between the wide and marginal excisions. Conclusion： The application of the wide or marginal excision for the primary lesion and bony metastasis focus, based on the principles of primary bone tumors, can significantly relieve the pain and improve the quality of life and limb function of patients primarily manifesting solitarv bone metastasis.