CAJ | 학술논문

目的分析下肢远端原发恶性骨肿瘤患者的生存情况,评估保肢后的肢体功能.方法 2003年11月至2010年1月,20例下肢肢体远端原发恶性骨肿瘤接受保肢或截肢手术.男性15例,女性5例,平均年龄20岁.肿瘤位置:胫骨远端14例,腓骨远端3例,跟骨3例.肿瘤分期:ⅠB期3例,ⅡB期16例,Ⅲ期1例.除3例胫骨下端肿瘤截肢外,其他11例胫骨远端肿瘤行自体骨(4例)或异体骨(7例)踝关节融合手术,6例腓骨远端和跟骨肿瘤行自体骨重建手术.平均随访36.4个月.结果 5例异体骨踝关节融合和1例跟骨自体骨重建患者伤口延迟愈合,自体骨和异体骨对伤口愈合的影响差异有统计学意义(P=0.036).2例异体骨出现吸收和不愈合(其中1例截肢,另1例更换为骨水泥临时假体),1例胫骨远端骨肉瘤术后11个月复发截肢,2例分别于确诊后22和48个月死于肺转移.患者2和5年的总生存率分别为92.9%和79.6%,12例高度恶性骨肉瘤的2和5年生存率分别为87.5%和70.0%.保肢患者功能MSTS评分为82%.结论下肢肢体远端原发恶性骨肿瘤的整体生存情况相对较好,保肢可以获得良好的肿瘤控制和肢体功能.
목적 분석하지원단원발악성골종류환자적생존정황,평고보지후적지체공능.방법 2003년11월지2010년1월,20례하지지체원단원발악성골종류접수보지혹절지수술.남성15례,녀성5례,평균년령20세.종류위치:경골원단14례,비골원단3례,근골3례.종류분기:ⅠB기3례,ⅡB기16례,Ⅲ기1례.제3례경골하단종류절지외,기타11례경골원단종류행자체골(4례)혹이체골(7례)과관절융합수술,6례비골원단화근골종류행자체골중건수술.평균수방36.4개월.결과 5례이체골과관절융합화1례근골자체골중건환자상구연지유합,자체골화이체골대상구유합적영향차이유통계학의의(P=0.036).2례이체골출현흡수화불유합(기중1례절지,령1례경환위골수니림시가체),1례경골원단골육류술후11개월복발절지,2례분별우학진후22화48개월사우폐전이.환자2화5년적총생존솔분별위92.9%화79.6%,12례고도악성골육류적2화5년생존솔분별위87.5%화70.0%.보지환자공능MSTS평분위82%.결론 하지지체원단원발악성골종류적정체생존정황상대교호,보지가이획득량호적종류공제화지체공능.
Objective To analyze the oncological and functional outcome of limb salvage in this location. Methods From November 2003 to January 2010, 20 patients with primary malignant bone tumors of the distal lower extremity were treated. There were 15 male and 5 female, the mean age was 20 years. Among 14 patients with malignant distal tibial sarcoma, 11 patients had ankle arthrodesis reconstructed by using allograft (7 patients) or autografts (4 patients), the other 3 patients underwent below-knee amputation. Three patients with osteosarcoma of distal fibula reconstructed with ipsilateral fibular head, 3 patients with calcaneus osteosarcoma underwent total calcanectomy and reconstructed with fibular segment and iliac crest. The mean follow-up was 36. 4 months. Results Five of 7 (71.4%) patients with allograft reconstruction were associated with delayed wound healing, however, only 1 of 10 patients with autograft had this problem (P =0.036). One local recurrence was observed, 2 osteosarcoma patients died of disseminated disease. The estimated 2-year and 5-year overall survival for the patients with malignant tibial sarcomas were 92.9% and 79.6% respectively, for the patients with distal tibial high-grade osteosarcoma were 87.5% and 70.0% respectively. The mean functional MSTS score was 82% for limb salvage patients. Conclusions The survival of patients with primary malignant bone tumor of distal lower extremity seems to be better than that of other sites. Limb salvage can provide satisfactory local control and functional results.