CAJ | 학술논문

目的：报告9例关节内原发恶性肿瘤病例，探讨合理的诊断方法及治疗方案。方法2001年8月至2011年7月共收治关节内原发恶性肿瘤的9例，其中男6例、女3例，年龄21～76岁、平均43.8岁。7例滑膜肉瘤(均为膝关节)，1例脂肪肉瘤(膝关节)，1例恶性弥漫性巨细胞瘤(髋关节)。回顾其临床表现、影像特点、诊断途径、手术方式，评价术后关节功能、并发症及转归。结果9例入院前均有关节疼痛，MRI典型表现为T1加权像低信号，T2加权像高信号或混杂信号伴明显强化，均接受手术治疗，术后平均随访27.5(12～60)个月，中位随访27个月，4例最终行截肢术，另5例保肢治疗后功能良好。结论关节内原发恶性肿瘤发病率极低；易误诊为良性病变。本组病例以膝关节滑膜肉瘤多见；术前需活检明确诊断，根据病理结果制订治疗方案(行新辅助化疗或术后放化疗)，患者能有良好的预后。根据MRI评估关节受累情况，需设计良好的外科切除边界；获得有效的肿瘤切除。
목적：보고9례관절내원발악성종류병례，탐토합리적진단방법급치료방안。방법2001년8월지2011년7월공수치관절내원발악성종류적9례，기중남6례、녀3례，년령21～76세、평균43.8세。7례활막육류(균위슬관절)，1례지방육류(슬관절)，1례악성미만성거세포류(관관절)。회고기림상표현、영상특점、진단도경、수술방식，평개술후관절공능、병발증급전귀。결과9례입원전균유관절동통，MRI전형표현위T1가권상저신호，T2가권상고신호혹혼잡신호반명현강화，균접수수술치료，술후평균수방27.5(12～60)개월，중위수방27개월，4례최종행절지술，령5례보지치료후공능량호。결론관절내원발악성종류발병솔겁저；역오진위량성병변。본조병례이슬관절활막육류다견；술전수활검명학진단，근거병리결과제정치료방안(행신보조화료혹술후방화료)，환자능유량호적예후。근거MRI평고관절수루정황，수설계량호적외과절제변계；획득유효적종류절제。
Objective To report 9 cases of intra-articular primary malignant tumors and to investigate the suitable diagnosis method and therapeutic scheme. Methods From August 2001 to July 2011, 9 patients with intra-articular primary malignant tumors were treated in our hospital. There were 6 men and 3 women with an average age of 43.8 years old ( range;21-76 years ). There were 7 cases of synovial sarcoma in the knee, 1 case of liposarcoma in the knee and 1 case of malignant diffuse-type tenosynovial giant cell tumors in the hip. The clinical features, image characteristics, diagnosis approaches and operative methods were retrospectively reviewed, and the postoperative joint function, side effects and prognoses were evaluated. Results All patients had pain in the joint before admission. The typical MRI features were low signal in T1 weighted images and high or mixed signal in T2 weighted images, which became enhanced markedly. The surgical treatment was performed on all the patients. The average follow-up period was 27.5 months ( range;12-60 months ), and the median follow-up period was 27 months. Four patients underwent amputation ifnally, and the other 5 patients had good joint function after the limb-salvage operation. Conclusions The incidence of intra-articular primary malignant tumors is low, and they may be easily misdiagnosed as benign tumors. The synovial sarcoma is the most common one in this group. Biopsy is needed before the operation to conifrm the diagnosis. The therapeutic scheme ( neoadjuvant chemotherapy or postoperative chemoradiotherapy ) can be made based on the pathological results, and the patients may had better prognoses. The joint involvement is evaluated according to the MRI images. The proper design of surgical margin may beneift the effective resection of tumors.