CAJ | 학술논문

目的：探讨2006年9月至2010年6月应用微波消融治疗股骨及胫骨普通骨肉瘤的疗效及并发症。方法本组共15例，男9例、女6例，中位年龄16(5～52)岁。发病部位：股骨远端6例、股骨干5例、胫骨近端4例，Enneking分期均为IIB期。所有患者经活检确诊后，术前多药联合化疗1周期。手术按恶性肿瘤广泛切除原则显露肿瘤，对瘤段骨行多根微波天线矩阵式微波消融。消融完成后清除坏死肿瘤组织，5例行自体或异体腓骨移植＋钢板内固定、3例行骨水泥填充＋钢板内固定、2例行自体或异体腓骨移植复合骨水泥填充＋钢板内固定、3例单纯钢板内固定、2例单纯髓内钉内固定术。术后同术前化疗方案行4周期辅助化疗。术后2年内每3个月，术后2年以上每6个月，术后5年以上每年复查1次，随访截至时间2013年12月。结果所有病例均获(51±20)个月的随访。术后复发并肺转移4例(复发时间术后平均10.2个月)、单纯肺部转移1例，该5例全部死亡；其余10例无瘤生存。复发率26.7%，3例为骨内复发，1例软组织复发；肺部转移率33.3%。2年和5年总生存率分别为73%和53%。6例出现病理骨折及内固定断裂，骨折率40%。术后半年评价患膝关节屈伸活动均接近正常，但长期随访出现病理骨折者的肢体功能明显恶化，术后3年病理骨折组评分明显低于无骨折组，差异有统计学意义(P＜0.01)。结论微波消融治疗下肢长骨骨肉瘤总体生存情况与国内目前整体治疗效果相当；由于灭活骨愈合过程漫长，行植骨及内固定重建后发生病理骨折风险较高；对下肢临关节骨肉瘤，瘤段骨扩大切除人工假体置换可能更为适宜。
목적：탐토2006년9월지2010년6월응용미파소융치료고골급경골보통골육류적료효급병발증。방법본조공15례，남9례、녀6례，중위년령16(5～52)세。발병부위：고골원단6례、고골간5례、경골근단4례，Enneking분기균위IIB기。소유환자경활검학진후，술전다약연합화료1주기。수술안악성종류엄범절제원칙현로종류，대류단골행다근미파천선구진식미파소융。소융완성후청제배사종류조직，5례행자체혹이체비골이식＋강판내고정、3례행골수니전충＋강판내고정、2례행자체혹이체비골이식복합골수니전충＋강판내고정、3례단순강판내고정、2례단순수내정내고정술。술후동술전화료방안행4주기보조화료。술후2년내매3개월，술후2년이상매6개월，술후5년이상매년복사1차，수방절지시간2013년12월。결과소유병례균획(51±20)개월적수방。술후복발병폐전이4례(복발시간술후평균10.2개월)、단순폐부전이1례，해5례전부사망；기여10례무류생존。복발솔26.7%，3례위골내복발，1례연조직복발；폐부전이솔33.3%。2년화5년총생존솔분별위73%화53%。6례출현병리골절급내고정단렬，골절솔40%。술후반년평개환슬관절굴신활동균접근정상，단장기수방출현병리골절자적지체공능명현악화，술후3년병리골절조평분명현저우무골절조，차이유통계학의의(P＜0.01)。결론미파소융치료하지장골골육류총체생존정황여국내목전정체치료효과상당；유우멸활골유합과정만장，행식골급내고정중건후발생병리골절풍험교고；대하지림관절골육류，류단골확대절제인공가체치환가능경위괄의。
Objective To investigate the curative effects and complications of microwave ablation in the treatment of conventional osteosarcoma in the femur and tibia. Methods From September 2006 to June 2010, 15 patients were adopted, including 9 males and 6 females with a median age of 16 years old ( range;5-52 years ). The locational distribution was stated as following. There were 6 cases in the distal femur, 5 cases in the femoral diaphysis and the other 4 cases in the proximal tibia. All the patients were classiifed as stage II B according to the Enneking staging system. After the diagnosis was confirmed by biopsy in all the patients, the combined chemotherapy was performed for 1 cycle before the surgery. The tumors were exposed according to the principle of wide resection of malignant tumors. The matrix microwave ablation with several antennas was performed on the tumor-bearing bone. The necrotic tumor tissues were removed after the ablation. The autogeneic or allogeneic ifbular grafting and plate ifxation were performed in 5 cases. The bone cementation and plate ifxation were performed in 3 cases. The autogeneic or allogeneic fibular grafting and plate fixation combined with bone cementation were performed in 2 cases. The simple plate fixation was performed in 3 cases. The simple intramedullary nail fixation was performed in 2 cases. Postoperatively the adjuvant chemotherapy was performed for 4 cycles after the preoperative chemotherapy. During the follow-up, the patients were reexamined at each 3 months during the first 2 years, and later at each 6 months. From the 5th year after the operation, reexamination was performed once 1 year until December 2013. Results All the patients were followed up for 51±20 months. Postoperatively 4 patients had recurrence and lung metastases with the mean recurrence time of 10.2 months and 1 patient had simple lung metastases, who all died. The other 10 patients remained cancer-free. The recurrence rate was 26.7%. The recurrence occurred in the bone in 3 cases, and in the soft tissues in 1 case. The rate of lung metastases was 33.3%. The 2-year and 5-year overall survival rates were 73%and 53%respectively. Pathological fractures and breakage of internal ifxation occurred in 6 cases, and the fracture rate was 40%. The lfexion and extension functions of the knee joints were evaluated at 6 months after the operation, which were close to normal. While in the long-term follow-up, the limb functions of the patients with pathological fractures were obviously aggravated. The scores of the patients with pathological fractures were obviously lower than that of the patients without fractures at 3 years after the operation, and the differences were statistically signiifcant ( P<0.01 ). Conclusions Because there are limited cases in this study, it is hard to draw a deifnite conclusion. However, there are some beneifcial prompts. For the patients with osteosarcoma in the long bones of the lower extremity, the overall survival rate of microwave ablation is comparable to that of other treatment methods in our country. While the technique should be further improved to make sure that the tumors are completely inactivated, so as to reduce the local recurrence. In addition, a long period is needed in the inactivation and recovery process and a high risk of pathological fractures exists after the bone grafting and internal ifxation, so a ifrmer reconstruction method should be adopted. In the treatment of osteosarcoma in the joints of the lower extremity, the tumor wide resection and artiifcial joint replacement maybe an ideal choice.