旋转成形术治疗股骨与胫骨上端恶性肿瘤(16例报告)

Long-term results following rotationplasty in the treatment of femur and proximal tibia malignant tumor (A report of 16 cases).

目的:探讨应用旋转成形术治疗股骨与胫骨上端恶性肿瘤的疗效。方法:回顾分析我院收治的下肢恶性肿瘤16例,包括股骨远端13例,股骨近端2例,胫骨上端1例。病理诊断:骨肉瘤9例,骨纤维肉瘤2例,恶性纤维组织细胞瘤2例,滑膜肉瘤、腺泡状肉瘤与骨巨细胞瘤Ⅱ～Ⅲ级各1例。外科分期:Enneking Ⅱb期15例,Ⅰb期1例。手术方式:按Winkelmann的分型,A1型13例,A2型1例,B1型2例。结合术前术后化疗6例,放疗2例。结果:全部病例无1例术中死亡,有15例经随访12个月～10年2个月,平均5年4个月,存活最短12个月,最长10年以上。2年内因肺转移死亡4例,2年以上存活11例,生存率73.3％,5年以上仍健在7例,生存率46.6％,其中有1例术后7年局部复发,再行局部切除。本组共复发2例,复发率13.3％。所有病人存活期间安装小腿假肢后,行走功能满意。结论:旋转成形术治疗股骨与胫骨上端恶性肿瘤,不但可获得较好的疗效,较低的复发率,具有保留或复建髋、膝关节功能的作用,能更好的负重,而且无患肢痛等优点。

Objective: To evaluate the long-term outcomes of rotationplasty in the treatment of femur and proximal tibia malignant lumor. Methods:Sixteen patients were involved. Nine were osteosarcoma,2 were fibrosarcoma of bone,2 were malignant fibrous histioeytoma, 1 was Synovial sarcoma,1 was adenosarcoma, and 1 was giant cell tumor ( Grade Ⅱ -Ⅲ). The tumor located in the distal lemur in 13 patients, the proximal femur in 2 ,and the proximal tibia in 1. The patients'age ranged from 9 to 45 years old with average of 27 years. Kolationplasty was performed on all 16 patients,while Winkelmann-lype AI for 13 cases,All for 1 case,and BI for 2 cases. Six palients received pre-and postoperative chemotherapy. Radiotherapy was used for 2 patients. Results:The follow-up period ranged from 12 months to 10 years and 2 months with an average of 64 months. The patients'survival period ranged from 12 months to more than ten years. Four patients died of lung metastasis is within 2 years. The 2 and 5 years survival rate were 73. 3% and 46. 6% respectively. Local recurrence was found in 2 cases. All patients achieved satisfactory walking function with the prosthesis on. Conclusion; Rotationplasty offers a convincing solution for the treatment of femur and proximal tibia malignant tumor. Benefit of reconstructed hip and knee fun-tion, belter weighl bearing,and no phantom pain can be expected from this approach without adverse impact on survival rate and local recurrence.