CAJ | 학술논문

目的探讨微波原位灭活联合人工假体置换术治疗四肢恶性骨肿瘤(侵袭范围超过骨全长2/3)的可行性.方法 2001年6月至2012年4月对19例侵袭范围超过骨全长2/3的原发恶性骨肿瘤及转移瘤患者采用微波灭活联合假体置换术进行治疗.男12例,女7例;年龄11～65岁,平均47岁.原发恶性骨肿瘤11例,转移瘤8例.股骨远端8例、胫骨近端6例、肱骨近端3例、股骨近端2例.术前X线、CT显示骨干皮质破坏小于骨全长的1/3,而MRI显示肿瘤侵袭范围超过骨全长2/3.依据MRI确定截骨范围,定制肿瘤型人工假体.采用常规肿瘤假体置换入路,按广泛切除原则充分显露瘤段骨及软组织肿块.使用铜网保护瘤段骨周围软组织,用2 450 MHz微波将瘤段骨内部加热到50℃,持续20 min,按术前测量长度进行截骨,人工关节假体重建,逐层缝合组织及皮肤.结果手术时间平均100 min,术中失血量平均600 ml.随访10个月～5年,平均2.7年.原发恶性骨肿瘤患者中1例术后出现复发,带瘤生存;2例术后其他部位转移,死亡;余8例随访期间未出现复发或转移.6例转移瘤患者分别于术后5～20个月出现其他部位转移,死亡;2例随访期间未出现原位复发或转移.3例肱骨近端肿瘤患者术后肩关节外展、上举功能受限,其余患者无关节功能受限.结论微波灭活联合人工假体置换术治疗髓腔内广泛受累的四肢恶性骨肿瘤,能最大限度地保留术后患者的肢体功能.
목적 탐토미파원위멸활연합인공가체치환술치료사지악성골종류(침습범위초과골전장2/3)적가행성.방법 2001년6월지2012년4월대19례침습범위초과골전장2/3적원발악성골종류급전이류환자채용미파멸활연합가체치환술진행치료.남12례,녀7례;년령11～65세,평균47세.원발악성골종류11례,전이류8례.고골원단8례、경골근단6례、굉골근단3례、고골근단2례.술전X선、CT현시골간피질파배소우골전장적1/3,이MRI현시종류침습범위초과골전장2/3.의거MRI학정절골범위,정제종류형인공가체.채용상규종류가체치환입로,안엄범절제원칙충분현로류단골급연조직종괴.사용동망보호류단골주위연조직,용2 450 MHz미파장류단골내부가열도50℃,지속20 min,안술전측량장도진행절골,인공관절가체중건,축층봉합조직급피부.결과 수술시간평균100 min,술중실혈량평균600 ml.수방10개월～5년,평균2.7년.원발악성골종류환자중1례술후출현복발,대류생존;2례술후기타부위전이,사망;여8례수방기간미출현복발혹전이.6례전이류환자분별우술후5～20개월출현기타부위전이,사망;2례수방기간미출현원위복발혹전이.3례굉골근단종류환자술후견관절외전、상거공능수한,기여환자무관절공능수한.결론 미파멸활연합인공가체치환술치료수강내엄범수루적사지악성골종류,능최대한도지보류술후환자적지체공능.
Objective To evaluate the clinical effectiveness of the treatment for the intramedullary broad dissemination of the malignant bone tumor of limbs by microwave heliotherapy combined with prosthesis replacement.Methods From June 2001 to April 2012,19 patients with intramedullary broad dissemination of malignant bone tumor of limbs were treated with microwave heliotherapy combined with prosthesis replacement.There were 12 males and 7 females,47 years old on the average (ranging from 11 to 65 years).The tumors involved:primary malignant tumor 11 cases,metastases of the scapula 8 cases.Locations of tumors involved:the distal femur 8 cases,the proximal tibia 6 cases,the proximal humerus 3 cases and the proximal femur 2 cases.After the patients were examined with MRI and the level of osteotomy was determined,the prostheses were custom-made.The exposures of the all tumors were via the conventional surgical approach.The lesions were heated at 50 ℃ for 20 min by 2 450 MHz microwave,with surrounding soft tissue protected by copper mesh.The level of osteotomy was determined by the result of preoperative imaging measurement.The prosthesis was installed after the microwave heliotherapy.Results The duration of surgery was from 60 min to 150 min (100 min on average).The blood loss was from 300 ml to 1200ml (600 ml on average).All patients were followed-up for 10 months to 5 years (2.7 years on average).1 case with chondrosarcoma relapsed 18 months after surgery,and survived with tumors.1 case with malignant fibrous histiocytoma died due to multiple metastases 8 months after surgery.1 case with Ewing sarcoma died due to pulmonary metastases 23 months after surgery.The remaining 7 cases with the primary malignant bone tumors did not recur or transfer during the follow-up period.6 cases with the metastases died due to metastases 5 to 20 months after surgery.The functions of shoulder joint of 3 proximal humerus tumor patients were restricted,while 16 patient's function weren't restricted.Conclusion The clinical results demonstrated that the microwave heliotherapy combined with prosthesis replacement was an ideal treatment for the intramedullary broad dissemination of the malignant bone tumor of limbs.