CAJ | 학술논문

背景:骨盆恶性肿瘤保肢和重建在其肿瘤学和再造学观点上仍存在争议.目的:观察计算机辅助设计人工假体重建髋臼周围肿瘤切除后骨盆稳定性的效果,以期最大限度保留肢体功能,减少复发.方法:纳入2002-04/2008-06解放军第二军医大学第一附属医院骨科收治的髋臼周围肿瘤患者33例,均行肿瘤切除及计算机辅助设计人工假体置换,其中18例(软骨肉瘤8例,尤文肉瘤2例,骨肉瘤2例,恶性纤维组织细胞瘤6例)配合抗肿瘤药物治疗.人工假体置换后进行骨盆功能评定,治疗效果分为优、良、可、差4级.结果及结论:2例患者分别于人工假体置换后4,6个月死亡:31例置换后随访8～32个月,平均12.5个月,其中7例软骨肉瘤复发,其他病例功能恢复情况为:优18例,良4例,可2例,差0例.均能保留患肢大部分功能和骨盆稳定性.结果提示,恶性纤维组织细胞瘤、Ewing肉瘤抗肿瘤药物治疗有效者保肢率高,局部复发率低;软骨肉瘤复发率高:髋臼周围肿瘤手术切除及计算机辅助设计人工假体置换可最大限度地保留肢体功能,提高生活质量.
배경:골분악성종류보지화중건재기종류학화재조학관점상잉존재쟁의.목적:관찰계산궤보조설계인공가체중건관구주위종류절제후골분은정성적효과,이기최대한도보류지체공능,감소복발.방법:납입2002-04/2008-06해방군제이군의대학제일부속의원골과수치적관구주위종류환자33례,균행종류절제급계산궤보조설계인공가체치환,기중18례(연골육류8례,우문육류2례,골육류2례,악성섬유조직세포류6례)배합항종류약물치료.인공가체치환후진행골분공능평정,치료효과분위우、량、가、차4급.결과급결론:2례환자분별우인공가체치환후4,6개월사망:31례치환후수방8～32개월,평균12.5개월,기중7례연골육류복발,기타병례공능회복정황위:우18례,량4례,가2례,차0례.균능보류환지대부분공능화골분은정성.결과제시,악성섬유조직세포류、Ewing육류항종류약물치료유효자보지솔고,국부복발솔저;연골육류복발솔고:관구주위종류수술절제급계산궤보조설계인공가체치환가최대한도지보류지체공능,제고생활질량.
BACKGROUND: There are disputes concerning limb salvage and reconstruction in treating pelvis malignant tumor.OBJECTIVE: To study the surgical treatment following resection of tumor at acetabular region in order to restore pelvic stability with less damage or recurrence.METHODS: Thirty-three patients diagnosed with pelvic tumor at Department of Orthopaedics, First Affiliated Hospital of Second Military Medical University from April 2002 to June 2008 were selected. All patients were received tumor resection and computer-aided prosthetic replacement, 18 patients (8 cases with chondrosarcoma, 2 cases with Ewing sarcoma, 2 cases with osteosarcoma, and 6 cases with malignant fibrous histiocytoma) were combined with antitumor drug treatment. Functional assessment of therapeutic efficacy was divided into 4 levels: excellent, good, moderate, and inferior.RESULTS AND CONCLUSION: Two patients died at months 4 and 6 after prosthetic replacement; 31 cases were followed-up for 8-32 months, mean 12.5 months. Seven cases were recurred chondrosarcoma, the recovery of other patients were as follow: 18 cases were excellent, 4 cases were good, 2 cases were moderate and no case was inferior. Most of limb function and pelvic stability was preserved. The results suggested that malignant fibrous histiocytoma and Ewing sarcoma can receive a high rate of limb preservation if treated by effective chemotherapy with low recurrence; the recurrence of chondrosarcoma was high. Tumor resection combined with computer-aided prosthetic replacement can maximatily reserve limb function and raise life quality.