CAJ | 학술논문

背景：骨肿瘤治疗的目标不仅仅是完整切除肿瘤组织，而且应最大限度的修复组织缺损并恢复受损功能，自体灭活骨是具有实用价值的移植和重建材料。 　　目的：探讨改良Malawer法结合瘤段截骨灭活回植治疗腓骨近端骨肿瘤的效果。 　　方法：内蒙古医科大学附属医院骨科2007年以来收治5例6侧腓骨近端肿瘤患者，分别采用股骨下段截肢、瘤腔内刮除植骨、腓骨上段截骨肿瘤切除+瘤段截骨加热(70℃蒸馏水中加热15 min)灭活回植内固定治疗，随访观察治疗效果。 　　结果与结论：1例截肢患者随访4年未见肿瘤复发和全身转移；1例瘤腔内刮除植骨患者术后1年复发；3例腓骨上段截骨肿瘤切除加热灭活回植内固定患者随访5个月，行走功能接近正常，膝关节外侧结构愈合好，拍片显示灭活骨截骨部尚未愈合，骨痂形成不明显，局部未见肿瘤复发，内固定无松动，灭活骨无骨折和吸收迹象。结果证实截肢和肿瘤刮除都有较明显的局限性；在Malawer术式基础上将瘤段截取骨灭活后回植能更好地保证小腿骨骼结构的完整性，原位重建膝关节外侧的股二头肌腱和侧副韧带止点，但灭活骨血运重建和愈合会随着灭活温度的提高而变得困难和缓慢，因而患者术后支具保护的时间应予以相对延长，允许剧烈运动的时间需要延迟，避免出现骨折等并发症。
배경：골종류치료적목표불부부시완정절제종류조직，이차응최대한도적수복조직결손병회복수손공능，자체멸활골시구유실용개치적이식화중건재료。 　　목적：탐토개량Malawer법결합류단절골멸활회식치료비골근단골종류적효과。 　　방법：내몽고의과대학부속의원골과2007년이래수치5례6측비골근단종류환자，분별채용고골하단절지、류강내괄제식골、비골상단절골종류절제+류단절골가열(70℃증류수중가열15 min)멸활회식내고정치료，수방관찰치료효과。 　　결과여결론：1례절지환자수방4년미견종류복발화전신전이；1례류강내괄제식골환자술후1년복발；3례비골상단절골종류절제가열멸활회식내고정환자수방5개월，행주공능접근정상，슬관절외측결구유합호，박편현시멸활골절골부상미유합，골가형성불명현，국부미견종류복발，내고정무송동，멸활골무골절화흡수적상。결과증실절지화종류괄제도유교명현적국한성；재Malawer술식기출상장류단절취골멸활후회식능경호지보증소퇴골격결구적완정성，원위중건슬관절외측적고이두기건화측부인대지점，단멸활골혈운중건화유합회수착멸활온도적제고이변득곤난화완만，인이환자술후지구보호적시간응여이상대연장，윤허극렬운동적시간수요연지，피면출현골절등병발증。
BACKGROUND:Apart from a complete resection of tumor tissues, the therapeutic goal for bone tumors is to maximize the repair and restoration of tissue defects and damaged functions. Autologous inactivated bone graft is of practical value for transplantation and reconstruction. OBJECTIVE:To investigate the effect of improved Malawer method combined with replantation of inactivated tumor segment in the treatment of proximal fibular tumors. METHODS: Since 2007, five patients with proximal fibular tumors (six sides) were admitted in the Affiliated Hospital of Inner Mongolia Medical University. These five patients were subjected to distal femoral amputation, intralesional curettage and bone grafting, upper fibular osteotomy + tumor segment heating (boiling in 70℃ distiled water for 15 minutes) + inactivated bone replantation. Therapeutic effects were folowed. RESULTS AND CONCLUSION: One case of amputation had no recurrence and systemic metastasis during 4 years of folow-up; one case of intralesional curettage and bone grafting relapsed 1 year after operation; three cases of upper fibular osteotomy + tumor segment heating + inactivated bone replantation folowed for 5 months recovered walking function and exhibited good healing of the outer structure of the knee, showing non-healing of inactivated tumor segment, non-remarkable calus formation, no local tumor recurrence, no loosening of internal fixation, and inactivated bone without fracture and absorption. These results confirmed that the tumor curettage and amputation both have obvious limitations; based on Malawer method, the replantation of inactive tumor segment can better ensure the structure integrity of the lower leg and in suit reconstruct the lateral biceps femoris tendon and the lateral colateral ligament, but geneticaly the revascularization and healing of inactivated bones wil be difficult and slow with temperature increases, and therefore the period of postoperative brace protection should be relatively extended, alowing time delay of strenuous exercise and avoiding complications such as fractures.