带血管蒂自体骨植入灭活瘤段骨在肢体恶性骨肿瘤中的应用  

The clinical research of devitalized bone and scapular vascular pedicle graft composite in treatment of malignant bone tumor

作　　者：宋金纲[1] 杨蕴[1] 张瑾[1] 赵军[1] 程明[1] 邢如维[1] 

机构地区：[1]天津医科大学附属肿瘤医院,300600

出　　处：《中国骨肿瘤骨病》2005年第6期321-324,共4页Chinse Journal Of Bone Tumor And Bone Disease

摘　　要：目的将带血管蒂的骨瓣植入灭活瘤段骨的保肢技术用于恶性骨肿瘤切除后的修复重建,探讨此技术的临床应用效果。方法自2000年4月～2005年3月对10例恶性骨肿瘤患者经新辅助化疗后,开展带血管蒂骨瓣植入与灭活瘤段骨回植联合应用的保肢技术。此方法为在距瘤缘5cm 外截断负瘤骨后,置高温水浴15min 再回植原位,灭活骨及截骨线远端健康骨开槽,取带血管蒂骨瓣植入灭活瘤段骨,予以内固定。结果 10例患者经5月～56月随访,无瘤生存9例,1例死于肺转移(未行术后化疗,局部无复发)。10例患者灭活骨均已成活并与健康骨及骨瓣愈合,肢体功能基本满意；较单纯灭活骨回植骨折愈合时间大为缩短。结论同其他保肢方法如：人工假体、自体或异体骨移植及其他灭活方法比较,此方法操作简单,灭活彻底,再植之灭活骨在带血运的骨瓣的血供作用下加快并保证了再生、成活及愈合,恢复了原来的解剖结构并获得了良好的功能；在一定程度上克服了灭活骨回植后易发生吸收、骨折不愈合、再骨折等缺点。Objective To evaluated the technique of the limb salvage by devitalized bone and scapular vascular pedicle graft composite after wide resection of the malignant bone tumor. Methods From April 2000 to March 2005, 10 cases of malignant tumor in humerus and tibia were treated by this procedure. There were 6 males and 4 females. There were 5 osteosarcomas and 4 malignant fibrous histiocytoma. 7 tumors located at proximal humerus and 1 in middle shaft of tibia and 2 in distal tibia. The functions of joints were evaluated pre-operatively and post-operatively based on MTST evaluation system. Tumors were resected in wide margin and reconstructed by devitalized bone and scapular vascular pedicle graft composite. Results All patients were followed-up for a period of 5 to 56 months （average 9 months） until devitalized bone healed well. 9 patients survived free of disease and 1 patient died of lung metastasis. The joint functions were excellent in 2 and good in 6 and approved in 1 and poor in 1. All patients were satisfied with the results of surgery. Conclusions This surgery is simple and easy to perform and devitalized tumor bone healed faster and satisfactory results has been obtained. There were less post-operative complications such as fracture and nonunion.

关 键 词：恶性骨肿瘤 肢体 灭活瘤段骨 带血管蒂骨瓣 

分 类 号：R738.1[医药卫生—肿瘤] R978.1[医药卫生—临床医学]