骨肉瘤穿越骺板侵袭骨骺的临床观察及机制初探

Primary Studies on Mechanism and Clinical Investigation of Epiphseal Extension of Osteosarcoma

目的 :观察骨肉瘤对骺板及骨骺的侵袭以及血管在其发生机制中的作用。方法 :复习 13例骺板未闭的骨肉瘤患者的资料 ,对 9例行数字减影动脉造影检查 ,对 7例术后大体标本进行观察 ,了解骨肉瘤穿越骺板侵袭骨骺的发生情况及机制。结果 :X线片显示 9例骺板被侵蚀 ,骨骺局部被破坏 ;4例未见骨骺受侵。 9例骨肉瘤患者DSA检查发现 8例在毛细血管期或肿瘤实质期时见肿瘤血管穿越骺板侵袭骨骺 ,在肿瘤实质期及静脉期见干骺端病变区及骺板、骨骺处有异常的血管网及瘤染 ,1例DSA检查时发现在动脉期见异常的肿瘤新生血管穿越骺板侵袭骨骺。结论 :骺板不能阻止骨肉瘤的侵袭 ,肿瘤血管多在毛细血管期穿越骺板侵袭骨骺 ,证明了血管再生或再通在骨肉瘤穿越骺板。

Objective:To investigate the mechanism and occurence of the epiphseal extension of osteosarcoma.Methods:The clinical and radiological materials of 13 with open epiphseal plate were reviewed.The DSA examinations were done in 9 of them,7 postoperative samples were investigated.Results:9 epiphseal plates were destroyed and the epiphseal extension were found in X ray films.The neoplastic vascular channals and neoplastic stainings in the epiphseal regions were showed in the capillary and venous phases from 8 DSA films,and in one DSA film,the neoplastic vascular channals and staining were found at the arterial phase.The epiphyseal extensions were seen in 7 postoperative samples.Conclusions:The epiphseal plate could not restain the extension of osteosarcoma,and the vascular connection or preexsit vascular channal open may provide the route for transepiphyseal extension of osteosarcoma and can be found by DSA examination.