保肢手术在不同年龄儿童骨肉瘤中应用的临床研究

Effects of extremity salvage surgery of osteosarcoma in children of different ages

目的探讨保肢手术在不同年龄儿童骨肉瘤中的应用方法与效果。方法选取本院2007年6月至2009年6月收治的骨肉瘤患儿57例为儿童组（年龄≤11岁），其中生物重建方式治疗38例，假体置换方式治疗19例；同期选取本院收治的60例青少年骨肉瘤患者作为对照组（年龄≥12岁），其中生物重建方式治疗42例，假体置换方式治疗18例。临床手术治疗后观察二组患儿的预后与生存率，通过统计学处理比较总结最佳保肢手术治疗方法。结果儿童组病例随访期间病死率为33．3％，1年生存率为（86．2±4．9）％，2年生存率为（70．2±6．8）％，3年生存率为（66．2±5．0）％，5年生存率为（57．4±4．3）％，与对照组比较差异有统计学意义（P〈0-05）。结论年龄因素对骨肉瘤的预后状况存在显著影响，而生物重建与假体置换均为儿童骨肉瘤的有效治疗方式。

Objective To explore the effects of extremity salvage surgery of osteosarcoma in children of different ages. Methods A total of 57 children aged under 11 years with malignant osteosarcoma from June 2008 to June 2011 were selected into children group. And 38 cases underwent biological reconstruction while another 19 cases received prosthesis. For control group, 60 adolescent patients aged above 12 years with malignant bone tumors during the same period were designated as control group. And 42 cases had biological reconstruction while 18 cases received prosthesis. The postoperative survival rates of three groups were observed. And the optimal extremity salvage surgery was summarized with statistical processing. Results During follow-ups, the mortality rate was 33.3 %. And 1, 2, 3 and 5-year survival rates were （86.2 ± 4.9）5, （70. 2± 6.8）%, （66.2± 5.0） and （57. 4± 4. 3） % respectively. Significant differences existed with control group （P〈 0. 05 ）. However, the prognoses of groups A and B showed no statistical significance （P〈0. 05）. And the overall incidence of postoperative complications had no significant difference between groups A and B （23.7% vs 31.6%, P〉0. 05）. Conclusions Age is a major prognostic factor for osteosarcoma. And extremity-sparing surgery and prosthetic reconstruction are effective treatments for children with osteosarcoma.