CAJ | 학술논문

目的分析新辅助化疗联合保肢术治疗骨肉瘤合并病理性骨折的疗效. 方法选择新辅助化疗基础上行保肢治疗的骨肉瘤合并病理性骨折患者68例为联合组,同期单纯手术治疗而未接受化疗或仅接受术后化疗的骨肉瘤合并病理性骨折患者22例为非化疗组,同期无病理性骨折在新辅助化疗基础上行保肢治疗的骨肉瘤患者48例为无骨折组,骨肉瘤合并病理性骨折行截肢治疗的患者32例作为截肢组.比较各组患者生存率、局部复发率、转移率及生存质量. 结果联合组平均预计生存时间较非化疗组显著延长(P＜0.05)；较无骨折组、截肢组差异无统计学意义.各组5年生存率比较,联合组较非化疗组显著增高(P＜0.05),较无骨折组、截肢组差异无统计学意义；非化疗组较截肢组、无骨折组显著降低(P＜0.05).联合组局部复发率较非化疗组显著降低(P＜0.01)；较无骨折组、截肢组差异无统计学意义.联合组转移率较非化疗组显著降低(P＜0.01)；较非骨折组、截肢组差异无统计学意义.联合组社会功能评分显著高于截肢组(P＜0.01)；生理职能较非化疗组、截肢组均显著增高(P＜0.05)；总体健康较非化疗组显著增高(P＜0.05)；其余各项评分各组比较差异均无统计学意义. 结论新辅助化疗联合保肢治疗骨肉瘤合并病理性骨折在保证患者生存率的前提下保存了肢体,并且不增加局部复发率及转移率,还可提高患者的生存质量,是治疗骨肉瘤合并病理性骨折的合理方法.
목적 분석신보조화료연합보지술치료골육류합병병이성골절적료효. 방법 선택신보조화료기출상행보지치료적골육류합병병이성골절환자68례위연합조,동기단순수술치료이미접수화료혹부접수술후화료적골육류합병병이성골절환자22례위비화료조,동기무병이성골절재신보조화료기출상행보지치료적골육류환자48례위무골절조,골육류합병병이성골절행절지치료적환자32례작위절지조.비교각조환자생존솔、국부복발솔、전이솔급생존질량. 결과 연합조평균예계생존시간교비화료조현저연장(P＜0.05)；교무골절조、절지조차이무통계학의의.각조5년생존솔비교,연합조교비화료조현저증고(P＜0.05),교무골절조、절지조차이무통계학의의；비화료조교절지조、무골절조현저강저(P＜0.05).연합조국부복발솔교비화료조현저강저(P＜0.01)；교무골절조、절지조차이무통계학의의.연합조전이솔교비화료조현저강저(P＜0.01)；교비골절조、절지조차이무통계학의의.연합조사회공능평분현저고우절지조(P＜0.01)；생리직능교비화료조、절지조균현저증고(P＜0.05)；총체건강교비화료조현저증고(P＜0.05)；기여각항평분각조비교차이균무통계학의의. 결론 신보조화료연합보지치료골육류합병병이성골절재보증환자생존솔적전제하보존료지체,병차불증가국부복발솔급전이솔,환가제고환자적생존질량,시치료골육류합병병이성골절적합리방법.
Objective To analyze the curative effect of neoadjuvant chemotherapy combined with limb salvage for osteosarcoma with pathologic fracture.Methods The cases were divided into combined group (68 cases of osteosarcoma with pathologic fracture who received limb salvage after neoadjuvant chemotherapy),non-chemotherapy group (22 cases of osteosarcoma with pathologic fracture who received operation without concurrent chemotherapy or chemotherapy only after operation),non-fracture group (48 cases of osteosarcoma without synchronous pathologic fracture who received limb salvage after neoadjuvant chemotherapy) and amputation group (32 cases of osteosarcoma combined with pathologic fracture who received amputation).Survival rate,local recurrence rate,metastasis rate and quality of life were compared between groups.Results Average estimated survival period of the combined group was obviously longer than that of the non-chemotherapy group (P ＜ 0.05),but had no significant difference from the non-fracture group or amputation group.Of the 5-year survival rate between groups,the combined group was evidently higher than the non-chemotherapy group (P ＜ 0.05),but without significant difference from the non-fracture group or amputation group.Whereas,non-chemotherapy group showed a lower 5-year survival rate than the amputation group or non-fracture group (P ＜ 0.05).Localized recurrence rate and metastasis rate of the combined group were markedly decreased when compared to the nonchemotherapy group (both P ＜ 0.01),but were not significantly different from the non-fracture group or the amputation group.The combined group showed a significantly higher score of social function than the amputation group (P ＜0.01),a significantly higher score of biological pofession than the non-chemotherapy group or the amputation group (P ＜ 0.05),and a significantly higher score of general health than the nonchemotherapy group (P ＜ 0.05).However,no significant differences were observed between groups regarding the scores for other items.Conclusion New adjuvant chemotherapy combined with limb salvage is a rational treatment of osteosarcoma with pathologic fracture for it saves the limb after the guarantee of survival rate without increasing the localized recurrence rate or metastasis rate,and improves quality of life.