股骨上段恶性骨肿瘤的手术治疗  

SURGICAL TREATMENT OF PROXIMAL FEMORAL MALIGNANT TUMORS

作　　者：王晋[1] 尹军强[1] 邹昌业[1] 谢显彪[1] 黄纲[1] 李浩淼[1] 沈靖南[1] 韩士英[1] 

机构地区：[1]中山大学附属第一医院骨肿瘤科,广州510080

出　　处：《中国修复重建外科杂志》2010年第7期881-884,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨采用广泛切除及功能重建手术方法治疗股骨上段恶性骨肿瘤的临床疗效。方法回顾分析1987年1月-2007年12月手术治疗的62例股骨上段恶性骨肿瘤患者临床资料。男29例,女33例;年龄14～73岁,中位年龄35岁。原发性肿瘤41例,病程0.5～14.0个月,平均2.5个月;其中骨肉瘤16例,纤维肉瘤7例,软骨肉瘤6例,恶性纤维组织细胞瘤6例,间叶源性肉瘤4例,尤文肉瘤1例,血管肉瘤1例;按Enneking分期:ⅠB期3例,ⅡA期2例,ⅡB期35例,Ⅲ期1例。转移性肿瘤21例,其中16例有恶性肿瘤史;病程0.1～28.0个月,平均3.4个月。术中行根治性切除9例,广泛性切除39例,边缘性切除14例。39例行人工假体重建(假体组),14例行假体异体骨复合物(allograft-prostheticcomposite,APC)重建(APC组),8例截肢,1例最终行全股骨人工关节置换手术。结果术后切口均Ⅰ期愈合。26例因肿瘤远处转移死亡,术后生存16～56个月,平均28个月;36例生存患者随访时间28～221个月,平均64个月。原发性肿瘤术后局部复发率为4.88%(2/41)。术后假体组出现股骨头脱位2例,假体柄断裂1例,髋部疼痛3例,髋臼磨损3例,假体柄周围松动5例;APC组出现移植骨与宿主骨不愈合3例,髋臼磨损1例。末次随访时,假体组患肢按国际骨与软组织肿瘤协会(MSTS)功能评分为77.69%±6.50%,APC组为85.71%±7.45%,差异有统计学意义(P<0.001)。结论股骨上段恶性骨肿瘤广泛切除后,可获得较好的局部控制;肿瘤切除后APC重建的患肢功能优于人工假体重建。Objective To evaluate the clinical outcomes of the wide resection and the functional reconstruction for treating malignant tumors of the proximal femur.Methods The clinical data were analysed from 62 patients with malignant tumors of the proximal femur treated between January 1987 and December 2007.There were 29 males and 33 females with a median age of 35 years（range,14-73 years）.In 41 patients with primary malignant tumors having a disease course of 0.5-14.0 months,there were 16 cases of osteosarcoma,7 cases of fibrosaroma,6 cases of chondrosarcoma,6 cases of malignant fibrous histiocytoma,4 cases of mesenchymal sarcoma,1 case of Ewing sarcoma,and 1 case of angiosarcoma,including 3 cases of type IB,2 cases of type ⅡA,35 cases of type ⅡB,and 1 case of type Ⅲ according to Enneking stage.In 21 patients with metastatic tumors,16 had a malignant tumor history;the disease course was 0.1-28.0 months（3.4 months on average）.Radical resection was performed in 9 cases,extensive resection in 39 cases,and marginal resection in 14 cases.After resection,39 cases underwent reconstruction with prostheses（prostheses group） and 14 cases underwent reconstruction with allograft-prosthetic composites（APC,APC group）.Results All incision healed by first intention.Twenty-six cases died of tumor metastasis,their postoperative survive time was 16-56 months（28 months on average）.The average follow-up time was 64 months（range,28-221 months） in 36 survival patients.The local recurrence rate of primary malignant tumors was 4.88%（2/41）.In prostheses group,dislocation of femoral head occurred in 2 cases,fracture of prosthetic stem in 1 case,hip pain in 3 cases,acetabular wear in 3 cases,and stem loosening in 5 cases.In APC group,nonunion of APC occurred in 3 cases and acetabular wear in 1 case.At last follow-up,the average Musculoskeletal Tumor Society（MSTS） functional scores were 77.69% ± 6.50% in prostheses group and 85.71% ± 7.45% in APC group,showing significant difference（P 0.001）.Conclusion Whe

关 键 词：股骨上段 恶性肿瘤 手术治疗 功能重建 

分 类 号：R738.1[医药卫生—肿瘤] R687.4[医药卫生—临床医学]