CAJ | 학술논문

目的：分析膝、肘关节以远肢体转移瘤临床发病特点及相关预后因素，并探讨此类罕见转移疾病的外科治疗方案。方法2000年1月至2013年6月，北京大学人民医院骨与软组织肿瘤中心诊治远端肢体转移瘤患者30例(41处肢体远端转移病变)，通过回顾其住院病历、影像学检查及病理学结果，总结其临床特征及诊断要点。41处病变中，位于胫骨者21处，尺骨8处，腓骨6处，桡骨3处，足3处。所有患者以VAS 评分评价疼痛程度。4例发生病理性骨折，未发生病理性骨折的长骨病变以 Mirels 评分评价骨折风险。28例接受手术治疗，手术患者以MSTS评分评价患者术后功能情况。统计学采用Kaplan-Meier法测算生存率，单因素分析采用t检验。结果28例手术患者中位生存期9个月，平均生存期13个月，半年生存率80.8%，1年生存率24.4%，2年生存率12.2%。未发生病理性骨折的长骨转移瘤 Mirels 评分平均为9.56分。入院平均VAS评分6.86分，接受手术治疗患者术后平均VAS评分2.63分。术后平均MSTS功能评分为22.85分。结论详细的病史采集、合理的影像学检查及肿瘤学筛查是明确诊断、避免误诊的必要条件，对于难以确诊的病例，需进行进一步活检。外科手术治疗结合术后放疗及全身治疗，可明显提高患者的生活质量。
목적：분석슬、주관절이원지체전이류림상발병특점급상관예후인소，병탐토차류한견전이질병적외과치료방안。방법2000년1월지2013년6월，북경대학인민의원골여연조직종류중심진치원단지체전이류환자30례(41처지체원단전이병변)，통과회고기주원병력、영상학검사급병이학결과，총결기림상특정급진단요점。41처병변중，위우경골자21처，척골8처，비골6처，뇨골3처，족3처。소유환자이VAS 평분평개동통정도。4례발생병이성골절，미발생병이성골절적장골병변이 Mirels 평분평개골절풍험。28례접수수술치료，수술환자이MSTS평분평개환자술후공능정황。통계학채용Kaplan-Meier법측산생존솔，단인소분석채용t검험。결과28례수술환자중위생존기9개월，평균생존기13개월，반년생존솔80.8%，1년생존솔24.4%，2년생존솔12.2%。미발생병이성골절적장골전이류 Mirels 평분평균위9.56분。입원평균VAS평분6.86분，접수수술치료환자술후평균VAS평분2.63분。술후평균MSTS공능평분위22.85분。결론상세적병사채집、합리적영상학검사급종류학사사시명학진단、피면오진적필요조건，대우난이학진적병례，수진행진일보활검。외과수술치료결합술후방료급전신치료，가명현제고환자적생활질량。
Objective The morbidity of metastatic lesions distal to the elbow and knee is quite low. To analyze the clinical characteristics and prognostic factors of metastatic diseases distal to the elbow and knee and to investigate the therapeutic strategies for such lesions.Methods A total of 30 patients ( 41 lesions ) with metastatic lesions in the distal extremities were treated from January 2000 to June 2013. The hospital records, radiographic reports and pathological results of each patient were reviewed, so as to summarize the clinical features and diagnostic points. 41 lesions included the tibia (n=21 ), the ulnar (n=8 ), the ifbula (n=6 ), the radius (n=3 ) and the foot (n=3 ). The Visual Analogue Scale ( VAS ) scoring system was used to evaluate the pain in the patients. Pathological fractures were detected in 4 patients, and the risk of impending pathological fractures in the other patients was evaluated by the Mirels scoring system. The surgical treatment was performed on 28 patients, whose postoperative functions were evaluated by the Musculoskeletal Tumor Society ( MSTS ) scoring system. The survival rate was described with the Kaplan-Meier survival curve, and the prognostic factors were analyzed by t-test.Results The median postoperative survival time and the mean postoperative survival time were 9 months and 13 months respectively. The half-year, 1-year and 2-year survival rates were 80.8%, 24.4% and 12.2%. The average Mirels score was 9.56 points in the patients with long bone metastases but without pathological fractures. The mean VAS score of the patients was 6.86 points at admission, which turned out to be 2.63 points after the operation. The mean postoperative MSTS score was 22.85 points.Conclusions The morbidity of metastatic diseases distal to the knee and elbow is very low. Detailed history-taking, appropriate radiographic examinations and oncology tests are essential for accurate diagnosis and avoidance of misdiagnosis. Biopsy is required when a deifnite diagnosis cannot be made. The quality of life of the patients can be signiifcantly improved with the surgical treatment combined with the postoperative radiotherapy and systemic therapy.