肢体骨肉瘤瘤段灭活再植的术后并发症

Complications of devitalized tumor segment grafts following segmental resections of limb osteosarcoma

目的:分析骨肉瘤患者接受瘤段灭活再植的术后并发症,评价该术式的临床价值。方法:1986年11月到1989年7月,39例肢体骨肉瘤患者行瘤段灭活再植术,平均随访43.5个月。瘤段灭活方法为液态氮冷冻24例,60Co照射13例,煮沸2例。结果:（1）29名患者发生了41例次的术后并发症,发生率为74.4％。11名患者因术后感染、肿瘤局部复发等原因而截肢。术后总评优良率为41.0％。（2）瘤段灭活再植术后主要并发症的发生率:肿瘤局部复发33.3％,术后感染15.4％,皮瓣坏死7.7％,骨折25.6％,骨不连10.3％。结论:采用液态氮冷冻、60Co照射、煮沸等方法行瘤段灭活再植,术后并发症发生率高,患者肢体功能较差。

Objective:Study on the operational results of patients with limb osteosarcoma who were treated with devitalized tumor segment grafting. Methods:39 patients suffered from limb osteosarcoma were treated with devitalized tumor segment grafting. The methods of tumor devitalization were frozen with liquid nitrogen, irradiated with 60Co and autolaved with boiling water. The average follow-up was 43.5 months. The bone junction healing time, complications and the end results of limb functions were compared among patients, and reasons of complications were analyzed too. Results: Of the 39 patients, 41.0% of the patients led to an overall result that was excellent and good. The frequency of main complications: infection 15.4%, skin necrosis 7.7%, local tumor recurrence 33.3%, non-union 10.6%, postoperative fracture 25.6 % , and which were of considerable significance in terms of effect on end result. 11 patients were amputated in reoperative procedures because of postoperative complications. Conclusion: The methods of devitalized tumor segment grafting developed more postoperative complications and led to worse limb functions.