CAJ | 학술논문

目的：探讨新辅助化疗联合保肢术治疗合并病理性骨折的骨肉瘤的疗效。方法选择2008年1月-2012年1月收治的48例合并病理性骨折的骨肉瘤患者为研究对象，随机分为观察组和对照组。观察组患者采用新辅助化疗联合保肢手术治疗，对照组患者采用截肢术＋术后辅助化疗治疗。比较2组患者的1、2、3年生存率、局部复发率、转移率、术后肢体功能评分情况及生存质量。结果观察组患者1、2、3年生存率分别为95．8％、87．5％、79．2％，对照组患者1、2、3年生存率分别为91．7％、83．3％、58．3％，2组比较，1、2年生存率无统计学意义（P＞0．05），但3年生存率观察组显著高于对照组（P＜0．05）。观察组患者肢体功能评分平均为（25．7±4．6）分，显著高于对照组的（11．3±2．7）分；观察组患者肢体功能评价的优良率为91．7％，显著高于对照组的70．8％，均具有统计学意义（P＜0．05）。观察组患者复发转移率为12．5％，显著低于对照组的33．3％，具有统计学意义（P＜0．05）。2组患者的不良反应主要为血液学毒性和胃肠道反应，差异无统计学意义（P＞0．05）。观察组患者的总体生存质量较对照组显著增高（P＜0．05）。结论新辅助化疗联合保肢术治疗合并病理性骨折骨肉瘤，疗效确切，安全可靠，可有效延长患者的生存时间，提高患者的生存质量，改善患者的预后，是治疗合并病理性骨折骨肉瘤的合理方法，值得在临床推广应用。
목적：탐토신보조화료연합보지술치료합병병이성골절적골육류적료효。방법선택2008년1월-2012년1월수치적48례합병병이성골절적골육류환자위연구대상，수궤분위관찰조화대조조。관찰조환자채용신보조화료연합보지수술치료，대조조환자채용절지술＋술후보조화료치료。비교2조환자적1、2、3년생존솔、국부복발솔、전이솔、술후지체공능평분정황급생존질량。결과관찰조환자1、2、3년생존솔분별위95．8％、87．5％、79．2％，대조조환자1、2、3년생존솔분별위91．7％、83．3％、58．3％，2조비교，1、2년생존솔무통계학의의（P＞0．05），단3년생존솔관찰조현저고우대조조（P＜0．05）。관찰조환자지체공능평분평균위（25．7±4．6）분，현저고우대조조적（11．3±2．7）분；관찰조환자지체공능평개적우량솔위91．7％，현저고우대조조적70．8％，균구유통계학의의（P＜0．05）。관찰조환자복발전이솔위12．5％，현저저우대조조적33．3％，구유통계학의의（P＜0．05）。2조환자적불량반응주요위혈액학독성화위장도반응，차이무통계학의의（P＞0．05）。관찰조환자적총체생존질량교대조조현저증고（P＜0．05）。결론신보조화료연합보지술치료합병병이성골절골육류，료효학절，안전가고，가유효연장환자적생존시간，제고환자적생존질량，개선환자적예후，시치료합병병이성골절골육류적합리방법，치득재림상추엄응용。
Objective To explore the curative effect of neoadjuvant chemotherapy combined with limb salvage surgery for osteosarcoma with pathological fractures .Methods 48 cases of patients with pathological fractures of osteosarcoma were se-lected as the research objects ,and they were randomly divided into the observation group and the control group with 24 cases in each group.Patients in the observation group were treated by neoadjuvant chemotherapy combined with limb salvage surgery ,pa-tients in the control group received the amputation surgery +postoperative adjuvant chemotherapy ,the 1,2,3-year survival rates, local recurrence ,metastasis rates ,postoperative limb function score and life quality of patients in the 2 groups were compared .Re-sults The 1,2,3-year survival rates of patients in the observation group were 95.8%、87.5%、79.2%,while that of patients in the control group were 91.7%,83.3%and 58.3%,there were no statistical significance (P>0.05) by comparing the 1,2-year survival rates between the 2 groups,but the 3-year survival rates in the observation group was significantly higher than that of the control group (P<0.05);The limb function scoring of patients in the observation group was (25.7+4.6) points averagely, which was significantly higher than that of the control group (11.3+2.7) points,the excellence rate of limb function evaluation of patients in the observation group was 91.7%,which was significantly higher than that of the control group (70.8%),they both had statistical difference (P<0.05);The recurrence and metastasis rate of patients in the observation group was 12.5%,which was significantly lower than that of the control group (33.3%),there was statistical difference (P<0.05);The adverse reactions of patients in the 2 groups were mainly the hematology toxicity and gastrointestinal reactions ,there was no statistical difference ( P>0.05).The overall life quality of patients in the observation group was significantly increasing compared with that of the control group (P<0.05).Conclusion The curative effect of neoadjuvant chemotherapy combined with limb salvage surgery in treat -ment of pathological fractures of osteosarcoma is exact ,it is safe and reliable ,and it can effectively prolong survival time ,improve quality of life and prognosis of patients .It is a reasonable way to treat the pathological fractures of osteosarcoma ,and it is worth popularizing in clinical application .