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目的探讨保留关节的瘤段切除酒精灭活骨再植术治疗股骨远端骨肉瘤的临床疗效,分析常见并发症的发生原因并提出治疗策略。方法 2004年1月至2011年5月,采用保留关节的瘤段切除酒精灭活再植术治疗股骨远端骨肉瘤10例。男7例,女3例;年龄15~24岁,平均20.1岁,中位年龄21岁;左股骨下段6例,右股骨下段4例;Enneking分期ⅡB期9例,Ⅲ期1例;术后疗效评价采用MSTS功能评分和ISOLS复合移植物影像评分。结果 10例术后切口均Ⅰ期愈合。随访12~110个月,平均随访34个月,1例13个月局部复发并全身多发转移而死亡。3例分别于术后9、12、24个月因全身多处转移而死亡。3例患者(30%)于术后2~9个月因灭活骨骨折而行切开复位、植骨、环抱器内固定术,1例于术后半年死亡;1例术后4个月骨折处愈合,再次术后48个月无异常。另1例再次术后13个月再次出现骨折而行切开复位、植骨、钢板内固定术,术后半年骨愈合良好,随访12个月出现关节不稳及膝关节屈曲受限。ISOLS影像评分28~34分,平均31分(87%);MSTS肢体功能评分19~28分,平均23分(77%)。结论在严格掌握适应证的前提下,应用保留关节的酒精灭活再植术治疗股骨远端干骺端骨肉瘤是一种可行的手术方式,具有保留关节的重要结构、瘤段骨与宿主骨匹配良好、无排异反应等优点。灭活骨骨折是该手术最常见的并发症,灭活骨自身骨质改变和内固定方式选择不当是导致骨折发生的主要原因。应用钢板内固定及延长外固定时间是降低灭活骨骨折的有效措施。
Objective To investigate the clinical efficacy of alcohol-inactivated bone replantation for the treatment of distal femoral osteosarcoma, and to analyze the causes of the common complications and to propose the treatment strategies. Methods From January 2004 to May 2011, 10 patients with distal femoral osteosarcoma were treated with alcohol-inactivated replantation of the reserved joint. There were 7 males and 3 females, aged 15-24 years (average 20.1 years) with a median age of 21 years. Six cases were in the left femur and 4 cases were in the right femur. Enneking stage ⅡB was 9 cases and stage Ⅲ was 1 case. Efficacy evaluation using MSTS function score and ISOLS composite graft imaging score. Results 10 cases of incision healed by first intention. All patients were followed up for 12 to 110 months with an average follow-up of 34 months. One patient died of local recurrence and systemic multiple metastasis at 13 months. Three cases died of multiple systemic metastases at 9, 12 and 24 months after operation. Three patients (30%) underwent open reduction, bone graft and embolization after 2 to 9 months postoperatively. One patient died within six months after operation, and one patient underwent four months after operation Fracture healing, again after 48 months without abnormalities. Another case of another 13 months after the recurrence of fractures again underwent open reduction, bone graft, plate fixation, bone healing six months after surgery was good, 12 months follow-up joint instability and knee flexion limited. ISOLS images score 28 to 34 points, an average of 31 points (87%); MSTS limb function score 19 to 28 points, an average of 23 points (77%). Conclusion Under the condition of strict indications, the treatment of distal metaphysis osteosarcoma with alcohol-inactivated replantation is a feasible surgical method, which has the important structure of retaining the joint, the tumor segment bone and the host bone Matching well, no rejection and other advantages. Inactivation of bone fractures is the most common complication of the operation. The main reason for the fracture is the improper selection of the bone inactivation bone and internal fixation. The use of plate fixation and prolongation of external fixation is an effective measure to reduce the in-bone fracture.