行保肢手术膝关节周围骨肉瘤患者的临床特征分析

Clinical Characteristics of Limb Salvage Surgery in Patients with Osteosarcoma around the Knee

目的评价行保肢手术膝关节周围骨肉瘤患者的预后、肢体功能、术后并发症及疗效。方法选取2012年2月-2013年7月150例经保肢手术治疗的骨肉瘤患者。对患者采用根治性切除或广泛性切除肿瘤手术,应用异体骨关节或人工关节假体方式进行重建和保肢手术,术前后对患者进行联合化疗。术后对患者进行1年随访,记录患者的临床资料。结果 150例患者5年总生存率为62.0%。规范化疗患者的5年生存率较不规范化疗患者显著提高(χ^2=11.670,P<0.001)。患者的骨与软组织协会(MSTS)功能平均评分为(25.48±3.09)分,与股骨下端骨肉瘤患者比较,胫骨上端骨肉瘤患者的平均关节伸直缺失度数更高(t=2.330,P=0.032)。共有10例患者术后随访期间进行了截肢手术,截肢原因包括:肿瘤再复发6例,假体感染4例。结论新辅助化疗联合保肢手术治疗方法能够较好保留膝关节骨肉瘤患者肢体外观和部分关节功能,患者的并发症较少,而术后患者发生再次截肢的主要原因是假体感染和肿瘤局部复发。

Objective To evaluate the prognosis, limb function, postoperative complications and surgical efficacy of patients. Methods 150 patients with osteosarcoma were treated by limb salvage surgery in our hospital from Februry2012 to July 2013. Patients underwent radical resection or extensive resection of the tumor, and allogeneic or artificial joint prosthesis was used for reconstruction and limb salvage surgery. The patients were treated with chemotherapy before and after surgery. The patients were followed up for 1 year and the clinical data of the patients were recorded. Results The 5-year overall survival rate of 150 patients was 62.0%. The 5-year survival rate of patients with standardized chemotherapy was significantly higher than that of patients with non-standard chemotherapy(χ^2=11.670, P<0.001). The average score of the Society for Bone and Soft Tissue Association(MSTS) was(25.48±3.09)points. Compared with patients with osteosarcoma of the lower femur, the average degree of joint extension was higher in patients with upper humeral osteosarcoma(t=2.330, P=0.032). A total of 10 patients underwent amputation during the follow-up period. The causes of amputation included 6 cases of tumor recurrence and 4 cases of prosthesis infection. Conclusion Neoadjuvant chemotherapy combined with limb salvage surgery can preserve the limb appearance and some joint functions of patients with knee osteosarcoma. The main cause of re-amplification in postoperative patients is prosthetic infection and local tumor recurrence.