CAJ | 학술논문

目的探讨骨盆肿瘤患者接受自体瘤骨灭活再植重建手术后的并发症、下肢功能及预后情况.方法回顾性分析2003年1月至2011年12月在北京大学人民医院骨与软组织肿瘤治疗中心接受灭活再植手术治疗的15例骨盆肿瘤患者的临床资料.男性11例,女性4例;年龄15～62岁,中位年龄31岁.肿瘤类型以软骨肉瘤(6例)和尤因肉瘤(3例)为主.手术切除大块肿瘤,去除骨外肿瘤包块,刮除松质骨内肿瘤,将残余骨壳放入65℃的20％高渗盐水灭活30 min;原位植入灭活骨,使用螺钉、钢板固定,累及髋臼者行全髋关节置换;必要时填充骨水泥提高骨强度.根据原发肿瘤类型和外科边界决定术后是否接受放疗和化疗等辅助治疗.术后定期进行随访,术后3、6个月、1年评估灭活骨愈合情况及下肢功能,分别应用国际保肢学会(ISOLS)移植骨评分和美国骨与软组织肿瘤学会(MSTS)评分.结果 1例患者术后2 d死于围手术期大出血,其余患者术后随访6～ 96个月,平均40.4个月,5例患者死于复发和转移.11例患者出现术后并发症,内固定相关机械并发症包括折断2例,关节脱位l例.深部感染3例,浅表感染4例.ISOLS评分显示移植骨愈合良好,为30.0％～95.0％,中位值81.0％;MSTS-93评分显示下肢功能中等,为23.0％～ 93.0％,中位值60.0％.结论对于低级别软骨肉瘤和化疗敏感的高度恶性肿瘤来说,肿瘤骨灭活再植是一种可行的重建技术.虽然并发症的发生率相对较高,但对预期生存期较长的患者中仍不失为一种重要的治疗方式.
목적 탐토골분종류환자접수자체류골멸활재식중건수술후적병발증、하지공능급예후정황.방법 회고성분석2003년1월지2011년12월재북경대학인민의원골여연조직종류치료중심접수멸활재식수술치료적15례골분종류환자적림상자료.남성11례,녀성4례;년령15～62세,중위년령31세.종류류형이연골육류(6례)화우인육류(3례)위주.수술절제대괴종류,거제골외종류포괴,괄제송질골내종류,장잔여골각방입65℃적20％고삼염수멸활30 min;원위식입멸활골,사용라정、강판고정,루급관구자행전관관절치환;필요시전충골수니제고골강도.근거원발종류류형화외과변계결정술후시부접수방료화화료등보조치료.술후정기진행수방,술후3、6개월、1년평고멸활골유합정황급하지공능,분별응용국제보지학회(ISOLS)이식골평분화미국골여연조직종류학회(MSTS)평분.결과 1례환자술후2 d사우위수술기대출혈,기여환자술후수방6～ 96개월,평균40.4개월,5례환자사우복발화전이.11례환자출현술후병발증,내고정상관궤계병발증포괄절단2례,관절탈위l례.심부감염3례,천표감염4례.ISOLS평분현시이식골유합량호,위30.0％～95.0％,중위치81.0％;MSTS-93평분현시하지공능중등,위23.0％～ 93.0％,중위치60.0％.결론 대우저급별연골육류화화료민감적고도악성종류래설,종류골멸활재식시일충가행적중건기술.수연병발증적발생솔상대교고,단대예기생존기교장적환자중잉불실위일충중요적치료방식.
Objective To analyze the clinical outcome of an operative technique using recycling bones to reconstruct pelvis after primary malignant pelvic tumor resection.Methods Fifteen patients who presented with malignant pelvic tumors were treated by wide or marginal resection and reconstruction using recycling bone in our institute from January 2003 to December 2011.The median age was 31 (15-62) years,and the most common diagnosis was chondrosarcoma,followed by Ewing sarcoma.The operative technique consisted of en-bloc excision of the pelvic tumor,removal of soft tissue,curettage of the tumor,incubated in 65 ℃ 20％ hypertonic saline for 30 minutes,reinplantation of recycling bone,and internal fixation with plates,screws and/or total hip replacement.Bone cement was used to augment bone strength when necessary.Bone healing features and function of lower limbs were evaluated with the International Society of Limb Salvage (ISOLS) graft evaluation method and Musculoskeletal Tumor Society (MSTS) score,respectively.Adjuvant therapies were used according to the type and extension of the primary tumor.Results One patient died of severe peri-operative bleeding 2 days after operation,and the other patients were followed-up for 6 to 96 months (mean 40.4 months),and 5 patients died of local recurrence or metastasis.Eleven operations were followed by complications of any kind.Most mechanical complications were related to the use of hip arthroplasties,where implant breakdown and dislocation were the commonest.Infection was seen in 7 cases (superficial 4 cases and deep 3 cases).Healing and functional scores were fair.The median ISOLS score and MSTS score were 81.0％ (range 30.0％ to 95.0％) and 60.0％ (range 23.0％ to 93.0％),respectively.Conclusions Recycling reconstruction technique is valid for young patients with low-grade chondrosarcoma or other chemo-sensitive tumor in pelvis.Although many complications are seen,this method remains our treatment of choice.