CAJ | 학술논문

目的探讨单纯使用CT测量肢体骨肉瘤髓内长度的准确性。方法回顾性对81例肢体骨肉瘤患者髓内长度进行CT测量，其中男46例，女35例，年龄10～60岁，中位年龄15岁，肿瘤位于股骨下段45例，胫骨上段23例，肱骨上段10例，股骨上段2例，胫骨下段1例，从工作站CT上测量关节面到肿瘤边界的长度，股骨上段肿瘤测量大转子尖到肿瘤边界的长度，所有患者均接受瘤段截除术，术后测量肿瘤的病理长度，将CT和病理测量的长度进行比较和统计学分析。结果81例患者测量的CT长度与病理长度进行配对t检查，t＝5.185，P＜0.01，二者差异有统计学意义；CT测量与病理测量误差在1cm之内的52例，准确率为64.2%，将此52例的CT长度与病理长度进行配对t检查，t＝-0.51，P＝0.959，二者差异无统计学意义。其余29例误差超过1cm的病例CT测量均比病理测量长，平均误差110(16～262)mm，对CT异常而病理无肿瘤的那部分截除髓腔测CT值及病理组织学分析，CT值显示增强前为-28～45HU，增强后为-10～87HU，组织学分析显示CT测量超出的部分髓腔组织学为红细胞系、白细胞系及血小板系造血细胞增生，未见肿瘤细胞。结论单纯使用CT测量骨肉瘤髓腔内长度准确性欠佳，不能区分肿瘤与增生骨髓，需要综合其他影像方式来判断骨肉瘤髓内长度以指导保肢手术。
목적탐토단순사용CT측량지체골육류수내장도적준학성。방법회고성대81례지체골육류환자수내장도진행CT측량，기중남46례，녀35례，년령10～60세，중위년령15세，종류위우고골하단45례，경골상단23례，굉골상단10례，고골상단2례，경골하단1례，종공작참CT상측량관절면도종류변계적장도，고골상단종류측량대전자첨도종류변계적장도，소유환자균접수류단절제술，술후측량종류적병리장도，장CT화병리측량적장도진행비교화통계학분석。결과81례환자측량적CT장도여병리장도진행배대t검사，t＝5.185，P＜0.01，이자차이유통계학의의；CT측량여병리측량오차재1cm지내적52례，준학솔위64.2%，장차52례적CT장도여병리장도진행배대t검사，t＝-0.51，P＝0.959，이자차이무통계학의의。기여29례오차초과1cm적병례CT측량균비병리측량장，평균오차110(16～262)mm，대CT이상이병리무종류적나부분절제수강측CT치급병리조직학분석，CT치현시증강전위-28～45HU，증강후위-10～87HU，조직학분석현시CT측량초출적부분수강조직학위홍세포계、백세포계급혈소판계조혈세포증생，미견종류세포。결론단순사용CT측량골육류수강내장도준학성흠가，불능구분종류여증생골수，수요종합기타영상방식래판단골육류수내장도이지도보지수술。
Objective To investigate the accuracy of simple CT measurement of intramedullary lengths of appendicular osteosarcomas. Methods The intramedullary tumor lengths of 81 patients with appendicular osteosarcomas were measured by CT, whose data were retrospectively studied. There were 46 males and 35 females, whose median age was 15 years old ( range;10-60 years ). The tumors were located at the distal femur in 45 patients, at the proximal tibia in 23 patients, at the proximal humerus in 10 patients, at the proximal femur in 2 patients and at the distal tibia in 1 patient. The CT was from the imaging station. The length was calculated from the joint level to the tumor margin. At the proximal femur, the length was measured from the tip of the greater trochanter to the tumor margin. All patients accepted tumor segment resection. The pathological measurement of tumor lengths was carried out postoperatively. The tumor lengths by CT and pathological measurements were compared, which were analyzed statistically. Results The tumor lengths by CT and pathological measurements in 81 patients were compared using the paired t-test, and there were statistically significant differences between them ( t=5.185, P<0.01). In 52 cases, the error was within 1cm, and the accuracy rate was 64.2%. The tumor lengths of the 52 cases by CT and pathological measurements were compared using the paired t-test, and there were statistically signiifcant differences between them ( t=-0.51, P=0.959 ). In the other 29 cases, the error was more than 1cm, and the tumor lengths by CT measurement were longer than that by pathological measurement. The mean error was 110 mm ( range;16-262 mm ). For the cavum medullare amputated, CT examination showed abnormal signs, and while pathological examination showed tumor-free signs. The CT values of this part were in the range of-28-45 HU before enhancement and-10-87 HU after enhancement. According to the histological analysis, the extra parts of the cavum medullare by CT measurement were hematopoietic cell proliferation of erythrocyte series, leukocytic series and thrombocytic series, and tumor cells were not found. Conclusions The accuracy of simple CT measurement of intramedullary lengths of appendicular osteosarcomas is not acceptable. The osteosarcoma and hyperplastic bone marrow can’t be differentiated just by CT measurement. Other imaging modalities can help make the measurement more precise, so as to guide the limb salvage surgery.