中国骨与关节杂志
中國骨與關節雜誌
중국골여관절잡지
Chinese Journal of Bone and Joint
2014年
2期
120-125
,共6页
于秀淳%许宋锋%徐明%袁冶%苏情
于秀淳%許宋鋒%徐明%袁冶%囌情
우수순%허송봉%서명%원야%소정
骨肉瘤%股骨%骨肿瘤%再植术%干垢端
骨肉瘤%股骨%骨腫瘤%再植術%榦垢耑
골육류%고골%골종류%재식술%간구단
Osteosarcoma%Femur%Bone neoplasms%Replantation%Dry scale end
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II B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。
目的：探討保留關節的瘤段切除酒精滅活骨再植術治療股骨遠耑骨肉瘤的臨床療效，分析常見併髮癥的髮生原因併提齣治療策略。方法2004年1月至2011年5月，採用保留關節的瘤段切除酒精滅活再植術治療股骨遠耑骨肉瘤10例。男7例，女3例；年齡15～24歲，平均20.1歲，中位年齡21歲；左股骨下段6例，右股骨下段4例；Enneking分期II B期9例，III期1例；術後療效評價採用MSTS功能評分和ISOLS複閤移植物影像評分。結果10例術後切口均I期愈閤。隨訪12～110箇月，平均隨訪34箇月，1例13箇月跼部複髮併全身多髮轉移而死亡。3例分彆于術後9、12、24箇月因全身多處轉移而死亡。3例患者(30％)于術後2～9箇月因滅活骨骨摺而行切開複位、植骨、環抱器內固定術，1例于術後半年死亡；1例術後4箇月骨摺處愈閤，再次術後48箇月無異常。另1例再次術後13箇月再次齣現骨摺而行切開複位、植骨、鋼闆內固定術，術後半年骨愈閤良好，隨訪12箇月齣現關節不穩及膝關節屈麯受限。ISOLS影像評分28～34分，平均31分(87%)；MSTS肢體功能評分19～28分，平均23分(77%)。結論在嚴格掌握適應證的前提下，應用保留關節的酒精滅活再植術治療股骨遠耑榦骺耑骨肉瘤是一種可行的手術方式，具有保留關節的重要結構、瘤段骨與宿主骨匹配良好、無排異反應等優點。滅活骨骨摺是該手術最常見的併髮癥，滅活骨自身骨質改變和內固定方式選擇不噹是導緻骨摺髮生的主要原因。應用鋼闆內固定及延長外固定時間是降低滅活骨骨摺的有效措施。
목적：탐토보류관절적류단절제주정멸활골재식술치료고골원단골육류적림상료효，분석상견병발증적발생원인병제출치료책략。방법2004년1월지2011년5월，채용보류관절적류단절제주정멸활재식술치료고골원단골육류10례。남7례，녀3례；년령15～24세，평균20.1세，중위년령21세；좌고골하단6례，우고골하단4례；Enneking분기II B기9례，III기1례；술후료효평개채용MSTS공능평분화ISOLS복합이식물영상평분。결과10례술후절구균I기유합。수방12～110개월，평균수방34개월，1례13개월국부복발병전신다발전이이사망。3례분별우술후9、12、24개월인전신다처전이이사망。3례환자(30％)우술후2～9개월인멸활골골절이행절개복위、식골、배포기내고정술，1례우술후반년사망；1례술후4개월골절처유합，재차술후48개월무이상。령1례재차술후13개월재차출현골절이행절개복위、식골、강판내고정술，술후반년골유합량호，수방12개월출현관절불은급슬관절굴곡수한。ISOLS영상평분28～34분，평균31분(87%)；MSTS지체공능평분19～28분，평균23분(77%)。결론재엄격장악괄응증적전제하，응용보류관절적주정멸활재식술치료고골원단간후단골육류시일충가행적수술방식，구유보류관절적중요결구、류단골여숙주골필배량호、무배이반응등우점。멸활골골절시해수술최상견적병발증，멸활골자신골질개변화내고정방식선택불당시도치골절발생적주요원인。응용강판내고정급연장외고정시간시강저멸활골골절적유효조시。
Objective To investigate the clinical outcomes of alcohol-inactivated autograft replantation with articulation preservation in the treatment of osteosarcoma in the distal femur, to analyze the occurrence of common complications and to propose the treatment strategies. Methods From January 2004 to May 2011, 10 patients with osteosarcoma in the distal femur were treated with alcohol-inactivated autograft replantation with articulation preservation. There were 7 males and 3 females, with an average age of 20.1 years old and a median age of 21 years old ( range;15-24 years ). Neoplasms were located in the left distal femur in 6 cases, and in the right distal femur in 4 cases. According to the Enneking staging system, 9 patients were identiifed as stage II B and 1 patient as stage III. The postoperative outcomes were evaluated according to the Musculoskeletal Tumor Society ( MSTS ) rating scale, and the International Society of Limb Salvage ( ISOLS ) composite graft scores were calculated. Results All the 10 cases were healed by primary intention. The mean follow-up period was 34 months ( range;12-110 months ). One patient died of local recurrence and systemic multiple metastases 13 months after the operation, and 3 patients died of systemic multiple metastases at 9, 12 and 24 months after the operation respectively. Three patients ( 30%) experienced the second operation of open reduction, bone implantation and internal ifxation with the embracing ifxator at 2-9 months after the operation because of inactivated bone fractures. One of them died at 6 months after the operation. One got bone healing at 4 months after the operation with no abnormal signs during the 48-month follow-up. One of the above 3 patients experienced the third operation of open reduction and bone implantation with plate internal ifxation because of the fractures 13 months after the second operation, who got bone healing at 6 months after the operation but had joint instability and limited knee lfexion during the 12-month follow-up. The mean ISOLS score was 31 points (87%) ( range;28-34 points ). The mean MSTS functional score was 23 points ( 77%) ( range;19-28 points ). Conclusions Based on the premise that the indications are strictly mastered, alcohol-inactivated autograft replantation with articulation preservation is a feasible operation method in the treatment of osteosarcoma in the distal femoral metaphysis, with the advantages of preserving important joint structures, good matching between the tumor-bearing bone and the host bone and no immunologic rejection. The inactivated bone fracture is the most common complication. The main causes of fractures are the change of inactivated bone quality and the inappropriate choice of internal ifxation. The fracture rate will be signiifcantly decreased if plate ifxation is chosen and the time of external ifxation is prolonged.
