CAJ | 학술논문

背景：骨肉瘤合并病理性骨折以往采用截肢治疗。随着新辅助化疗的临床应用，人工假体制作工艺和材料的改进，部分骨肉瘤合并病理性骨折的患者获得了保肢治疗的可能。目的：探讨特制人工膝关节假体置换在骨肉瘤合并病理性骨折保肢治疗中的效果。方法：2002年6月至2012年9月共收治11例临近膝关节骨肉瘤合并病理性骨折患者，根据患者的个体情况定制肿瘤膝关节假体行保肢治疗，对其随访结果进行回顾性分析。其中男6例(54.5%)，女5例(45.5%)；年龄11-50岁，平均25.4岁；发病部位：股骨远端7例，胫骨近端4例。所有患者均接受新辅助化疗并应用特制膝关节假体行保肢治疗，随访时间9-105个月。结果与结论：11例患者假体置换后局部复发率为18%，肺转移率为36%，5年生存率为58%。4例患者发生肺转移，死亡时间为假体置换后9-24个月。末次随访患肢Enneking评分11-30分，平均23.3分，优良率为82%。提示应用特制膝关节假体置换联合新辅助化疗方案，对膝关节周围骨肉瘤合并病理骨折患者行保肢治疗近期效果理想，远期疗效尚需评价。
배경：골육류합병병이성골절이왕채용절지치료。수착신보조화료적림상응용，인공가체제작공예화재료적개진，부분골육류합병병이성골절적환자획득료보지치료적가능。목적：탐토특제인공슬관절가체치환재골육류합병병이성골절보지치료중적효과。방법：2002년6월지2012년9월공수치11례림근슬관절골육류합병병이성골절환자，근거환자적개체정황정제종류슬관절가체행보지치료，대기수방결과진행회고성분석。기중남6례(54.5%)，녀5례(45.5%)；년령11-50세，평균25.4세；발병부위：고골원단7례，경골근단4례。소유환자균접수신보조화료병응용특제슬관절가체행보지치료，수방시간9-105개월。결과여결론：11례환자가체치환후국부복발솔위18%，폐전이솔위36%，5년생존솔위58%。4례환자발생폐전이，사망시간위가체치환후9-24개월。말차수방환지Enneking평분11-30분，평균23.3분，우량솔위82%。제시응용특제슬관절가체치환연합신보조화료방안，대슬관절주위골육류합병병리골절환자행보지치료근기효과이상，원기료효상수평개。
BACKGROUND:Osteosarcoma combined with pathological fracture was often treated by amputation. With clinical application of neoadjuvant chemotherapy and improvement of technology and material of the prosthesis, the limbs of patients with osteosarcoma combined with pathological fracture were reserved. OBJECTIVE:To evaluate the effect of the application of custom-manufactured artificial total knee prosthesis replacement in limb salvage treatment for patients with osteosarcoma combined with pathological fracture. METHODS:A total of 11 patients with pathological fracture with osteosarcoma located in adjacent knee Joint were enrol ed from June 2002 to September 2012. In accordance with individual condition of the patient, limb salvage treatment was designed for knee prosthesis for a tumor. Fol ow-up results were retrospectively analyzed. There were six males (54.5%) and five females (45.5%) and their age ranged from 11 to 50 years old with an average age of 25.4 years old. Onset regions:seven tumors were located in the distal femur and four tumors were in the proximal tibia. Al patients received neoadjuvant chemotherapy, and limb salvage treatment with custom-manufactured artificial knee prosthesis. The fol ow up was performed for 9 to 105 months. RESULTS AND CONCLUSION:In 11 patients after prosthesis replacement, the regional recurrence rates were 18%, lung metastasis rates were 36%. The five-year survival rate was 58%. Four patients developed lung metastases and died in 9 to 24 months postoperatively. During the last fol ow-up, Enneking score of the affected limbs was 11 to 30 points, averagely 23.3 points, with an excellent and good rate of 82%. Results indicated that combined with neoadjuvanet chemotherapy, the application of custom-manufactured artificial total knee prosthesis replacement in the treatment of osteosarcoma located in adjacent knee joint and pathological fracture achieved an ideal outcomes of the limb salvage treatment in the near future. The lone-term effectiveness was expected to be evaluated.