肿瘤假体置换术与瘤段灭活再植术治疗四肢骨肉瘤效果观察

Efficacy observation of prosthetic replacement for bone tumors and devitalization and replantation after resection of tumor segment for treatment of extremity osteosarcoma

目的评价保肢手术肿瘤假体置换术与瘤段灭活再植术治疗四肢骨肉瘤患者的效果。方法以2010年12月至2017年6月于山西医科大学第二医院行保肢手术治疗的54例EnnekingⅡ期四肢骨肉瘤患者为研究对象。采用Kaplan-Meier法对肿瘤假体置换术组与瘤段灭活再植术组患者进行生存分析,比较两组患者的5年生存率及远处转移率。采用χ^2检验和t检验对两组患者局部复发率以及局部感染发生率、术后功能恢复情况进行比较。结果46例骨肉瘤患者获得随访,随访时间3~84个月。肿瘤假体置换术组35例,瘤段灭活再植术组11例。Kaplan-Meier生存分析显示,肿瘤假体置换术组与瘤段灭活再植术组患者5年生存率及远处转移率比较(52.5%比59.4%,38.5%比35.7%),差异均无统计学意义(χ^2值分别为0.084、0.013,均P>0.05)。瘤段灭活再植术组局部复发率、患肢局部感染率均高于肿瘤假体置换术组[36.4%(4/11)比8.6%(3/35),36.4%(4/11)比11.4%(4/35)],差异均有统计学意义(χ^2值分别为4.181、5.020,均P<0.05)。两组患者术后6个月功能评分比较显示,瘤段灭活再植术组功能恢复差于肿瘤假体置换术组[(17.4 ±2.5)分比(24.3±4.8)分],差异有统计学意义(t=-4.911,P<0.05);术后18个月功能评分比较显示,瘤段灭活再植术组功能评分有所上升,高于肿瘤假体置换术组[(27.3 ±2.7)分比(24.8±4.6)分],但差异无统计学意义(t=1.811,P>0.05)。结论肿瘤假体置换术疗效优于瘤段灭活再植术,可作为现阶段四肢骨肉瘤患者保肢治疗时的首选手术方式。

To evaluate the efficacy of prosthetic replacement for bone tumors and devitalization and replantation after resection of tumor segment for the treatment of patients with extremity osteosarcoma. Methods A total of 54 patients with Enneking stage Ⅱ extremity osteosarcoma who underwent limb-salvaging surgery in the Second Hospital of Shanxi Medical University from December 2010 to June 2017 were analyzed. Kaplan-Meier survival analysis was performed on the prosthetic replacement for bone tumors group and devitalization and replantation after resection of tumor segment group, the 5-year survival rate and distant metastasis rate between the two groups were compared. The χ^2 test and t test were used to compare the local recurrence rate, occurrence of local infection, and postoperative functional recovery between the two groups. Results Forty-six patients were followed up with the period ranging from 3 to 84 months. The prosthetic replacement for bone tumors group had 35 cases and the devitalization and replantation after resection of tumor segment group had 11 cases. The postoperative 5-year survival rate and 5-year distant metastasis rate were compared between the prosthetic replacement for bone tumors group and devitalization and replantation after resection of tumor segment group by using the Kaplan-Meier method (52.5% vs. 59.4%, 38.5% vs. 35.7%), and the differences were not statistically significant (χ^2 values were 0.084 and 0.013, both P > 0.05). For local recurrence rate and the risk of postoperative infection, the patients in devitalization and replantation after resection of tumor segment group showed higher results than those in prosthetic replacement for bone tumors group [36.4%(4/11) vs. 8.6%(3/35), 36.4%(4/11) vs. 11.4%(4/35)], and the differences were statistically significant (χ^2 values were 4.181 and 5.020, both P < 0.05). For 6 months postoperative functional reconstruction score, the patients in devitalization and replantation after resection of tumor segment group showed worse result than that in prosthetic replacement for bone tumors group [(17.4±2.5) points vs.(24.3±4.8) points], and the difference was statistically significant (t=-4.911, P < 0.05);but this index tended to show better result at 18 months after surgery as compared with prosthetic replacement for bone tumors group [(27.3±2.7) points vs.(24.8±4.6) points], but the difference was not statistically significant (t= 1.811, P > 0.05). Conclusion The efficacy of prosthetic replacement for bone tumors is considered better than that of devitalization and replantation after resection of tumor segment, and it could be used as the preferred surgical option for limb-salvaging treatment in patients with extremity osteosarcoma at present.