恶性骨肿瘤保肢术并发症的原因及治疗

The Causes and Therapies of Complications in the Malignant Bone Tumor Salvage Limb Operations

目的 :分析恶性骨肿瘤保肢术并发症发生的原因及其治疗。方法 :我院 7年半间对 86例恶性骨肿瘤行保肢术 ,其中 2 2例出现了不同的并发症 ,同期收治外院资料完整的保肢术并发症患者 8例。男 2 2例 ,女 8例。年龄平均2 3 .5岁。部位 :胫骨上端 12例 ,腓骨上端 4例 ,股骨下端 9例 ,尺骨远端、肱骨近端、桡骨远端、胫骨远端、髂骨各 1例。骨肉瘤 18例 ,骨巨细胞瘤 7例 ,软骨肉瘤 2例 ,皮质旁骨肉瘤、骨纤维肉瘤和恶性纤维组织细胞瘤各 1例。复发 18例 ,切口感染和延迟愈合 7例 ,神经损伤 5例 ,异体骨或灭活骨骨折 5例。结果 :除 4例拒绝治疗外 ,13例行截肢或关节离断术 ,4例行扩大切除术 ,肌皮瓣转位术和人工关节置换术各 2例 ,清创缝合术 ,石膏外固定及切开复位内固定术各 1例。另 2例神经损伤患者未予处理。 2 1例获得平均 2 0 .2月的随访 (3月～ 6年 ) ,4例死亡 ,3例带瘤生存 ,余 14例无异常。结论 :术后复发与术中切除不彻底 ,种植和治疗不当有关 ;切口感染和延迟愈合多发生于胫骨上端 ;神经损伤除与手术有关外 ,还与放疗不当有关 ;异体骨或灭活骨骨折多发生于术后 2～ 12月。

Objective:Analysing the causes of complications in the malignant bone tumor salvage limb operations and exploring the therapies for them.Methods:There were 22 cases in male,8 in female and with the mean age of 23.5 years old.18 in osteosarcoma,7 in giant cell tumor of bone,2 in chondrosarcoma,each one in juxtacortial osteosarcoma,osteofibrosarcoma and malignant fibrous histiocytoma respectively.18 patients happened recurrent postoperatively,7 with incisional problems,5 with nervous injure and 5 with xenogenous bone or deactivated bone fracture.Results:4 cases refused to receive treatment,amputations were performed in 13 cases,en bloc resection in 4 cases,myo skin flap translocation and the special prothesis replacement in 2 cases,each in the debridement suture,plaster immobilization and open reduction.2 nervous injure patients were not treated.21 cases were done follow up with the mean time of 20.2 months.4 cases died.Conclusion:The postoperative recurrent related with the resection incompletly;the incision problems often happened in the upper end of tibia,the different therapies were used according to the different complications.