肢体肿瘤所致病理性骨折的早期诊断与治疗  

Early Diagnosis and Treatment of Pathological Fractures Caused by Bone Tumors of the Extremities

作　　者：姚长海[1] 侯树勋[1] 刘汝落[1] 高天君[1] 张健[1] 

机构地区：[1]解放军第三○四医院骨科,北京100037

出　　处：《中华骨科杂志》1999年第7期418-420,共3页Chinese Journal of Orthopaedics

摘　　要：目的正确认识肢体肿瘤所致病理性骨折的概念和病因，掌握早期诊断与鉴别诊断方法，减少误诊、误治，提高治疗效果。方法１９８１年门月～１９９７年１０月共收治肢体肿瘤所致病理性骨折患者１６２例，其中良性肿瘤与肿瘤样病损８５例，恶性肿瘤７７例。治疗原则：良性肿瘤行刮除植骨，根据不同情况分别采用张力带钢丝、钢板螺钉、石膏以及单臂外固定架进行固定。恶性肿瘤要在配合化疗和放疗基础上分别采用肿瘤段切除灭活再植、开创放疗、异体半关节移植，对于无保肢条件者实行截肢。结果１６２例病理性骨折经过上述治疗均能愈合。以良性骨肿瘤与肿瘤样病损作为原发病的８５例术后１０个月内复发４例；１０～１２个月复发２１例；１～５年复发１２例。恶性骨肿瘤７７例的两年生存率为７８％，五年生存率为４２％。结论肢体肿瘤所致病理性骨折的治疗并不困难，关键是原发病的早期诊断与鉴别诊断。诊断时要认真询问病史和受伤机制，骨折前有夜间痛、轻度外伤就出现骨折要想到肢体肿瘤所致病理性骨折的可能。Objective To describe the concept and etiology of the pathological fractures caused byextremity bone tumors and their diagnosis and differential diagnosis to improve the outcome. Methods Between December 1981 and October 1997, 162 patients with pathological fracture caused by extremity bonetumors were treated. The pathology could be classified as benign bone tumors and tumor-like lesions in 85cases and malignant.bone tumors in 77. Various methods of internal and external fixation were used accordingto the type of the fracture. For the benign bone tumors, additional curettage and hone grafting were performed.For the malignant hone tumors, chemotherapy and radiotherapy were used in addition. ResultS Through theinternal or external fixation, primary healing of fracture was achieved. The local recurrence within I year wasseen in 25 patients and within 5 years in 12 out of 85 patients with benign bone tumors. Among the 77 patientswith malignant bone tumors, two years survival rate was 78% and five years survival rate 42%. ConclusionEarly and differential diagnosis of the primacy lesions is vitally imPOrtant for surgical management of thepathological fractures caused by extremity bone tumors. Careful investigation of the history and injury mechanism is necesseq for the diagnosis. Night pain before fracture and the fracture caused by mild force remind thesurgeon the possibility of a pathological fractures.

关 键 词：四肢 肢体肿瘤 骨折 病理性 诊断 治疗 

分 类 号：R739.960.6[医药卫生—肿瘤] R683[医药卫生—临床医学]