股骨上段恶性骨肿瘤的诊断和治疗  

Diagnosis and treatment of malignant tumors in the proximal segment of the femur

作　　者：王晋[1] 沈靖南[1] 韩士英[1] 李佛保[1] 廖威明[1] 付明[1] 孟悛非[2] 丘钜世[3] 

机构地区：[1]中山大学附属第一医院骨科 [2]中山大学附属第一医院放射科,广州510080 [3]中山大学附属第一医院病理科,广州510080

出　　处：《中国骨肿瘤骨病》2002年第6期353-356,共4页Chinse Journal Of Bone Tumor And Bone Disease

摘　　要：目的 分析股骨上段骨肿瘤误诊的原因,评价治疗方法。方法 回顾性分析了38例股骨上段恶性骨肿瘤的诊断和治疗经验。结果 38例股骨上段恶性骨肿瘤中,23例原发性肿瘤,15例转移性肿瘤。首诊获得确诊的30例行股骨上段人工假体置换,其中15例系原发性肿瘤,平均生存40.36个月,Enneking功能评分恢复85.78％。原发瘤中8例误诊为良性疾病而行瘤内刮除,误诊率为34.8％(8/23),7例再次手术行髋关节离断术,1例放化疗2年后行全股骨置换术,平均生存23.62个月;另15例系转移性肿瘤,平均生存23个月,Enneking功能评分恢复78.81％。结论 股骨上段的原发性恶性骨肿瘤容易误诊为良性病变而延误治疗,降低了生存期,粗针多点穿刺、抓住诊断线索举行临床、病理和影像学三结合讨论是减少误诊的关键环节。股骨上段的原发性恶性骨肿瘤和单发性转移瘤或并发病理性骨折,在新辅助化疗的配合下,应积极进行瘤段切除+股骨上段假体置换手术,思肢功能满意;部分原发性肿瘤获得长期生存;转移瘤患者改善生活质量,创造了进一步辅助治疗的条件。Objectives To sum up the experiences of the diagnosis and treatment of malignant tumors in the proximal segment of the femur. Methods This is a retrospective investigation of the malignant tumors in the proximal femur encountered in the recent ten years, analyzing the percentage and reason of misdiagnoses and outcome of treatment. Result Among the 38 cases of the malignant tumors in the proximal femur, i 23 cases were of the primary malignant lesion and 15 cases of metastasises; In the primary malignant lesions, 8 were misdiagnosed as benign tumor and were treated with intra - lesion curretage. The rate of misdiagnoses of primary malignant tumors was 34.8 % (8/23) ; 7 of the 8 cases had revision operation of hip disarticulation. and one of 8 cases have the revision surgery of limb savage undergone total femur replacement with metallic endoprosthetic after chemotherapy and radiation therapy for two years. With the misdiagnose the average survival period was 23.62 month. The 30 cases of 38 cases corrected diagnosed at the first visit had the operation of limb savage, proximal femur replacement with metallic endoprosthetic. The 15 cases with no misdiagnoses of primary malignant tumors survived averagely for 40.36 month, and the Enneking function score of post-operation recover of 85.78% (25.73/30) . The 15 cases of metastasis survived averagely for 23 month, the Enneking function score of post - operation recover was 78.81 % (23.64/30) . Conclusions The diagnosis of the primary tumors of the upper end of the femur was really difficult and the percentage of misdiagnosis for the primary tumors in the proximal femur is high. Oftentimes, the malignant tumors are misdiagnosed for benign lesions and the proper management is delayed and the period of survival of the patients shortened. The clues of correct diagnosis consists of the synthesizing analysis of epidemiology, clinical features, tomography and pathology, and also important is the method of multple puncture biopsy with the thick needle. The distinguishing diagnosi

关 键 词：股骨 骨肉瘤 肿瘤转移 诊断 

分 类 号：R738.1[医药卫生—肿瘤]