新辅助化疗联合保肢治疗骨肉瘤合并病理性骨折  

New adjuvant chemotherapy combined with limb salvage for osteosarcoma combined with patho- logic fracture

作　　者：罗仁峰[1] 何安兵[2] 陈春洲 

机构地区：[1]武汉市江汉大学医学院肿瘤科,430056 [2]江汉大学第二附属医院肿瘤内科 [3]肿瘤外科

出　　处：《中华创伤杂志》2013年第4期334-337,共4页Chinese Journal of Trauma

摘　　要：目的分析新辅助化疗联合保肢术治疗骨肉瘤合并病理性骨折的疗效。方法选择新辅助化疗基础上行保肢治疗的骨肉瘤合并病理性骨折患者68例为联合组，同期单纯手术治疗而未接受化疗或仅接受术后化疗的骨肉瘤合并病理性骨折患者22例为非化疗组，同期无病理性骨折在新辅助化疗基础上行保肢治疗的骨肉瘤患者48例为无骨折组，骨肉瘤合并病理性骨折行截肢治疗的患者32例作为截肢组。比较各组患者生存率、局部复发率、转移率及生存质量。结果联合组平均预计生存时间较非化疗组显著延长（P〈0．05）；较无骨折组、截肢组差异无统计学意义。各组5年生存率比较，联合组较非化疗组显著增高（P〈0．05），较无骨折组、截肢组差异无统计学意义；非化疗组较截肢组、无骨折组显著降低（P〈0．05）。联合组局部复发率较非化疗组显著降低（P〈0．01）；较无骨折组、截肢组差异无统计学意义。联合组转移率较非化疗组显著降低（P〈0．01）；较非骨折组、截肢组差异无统计学意义。联合组社会功能评分显著高于截肢组（P〈0．01）；生理职能较非化疗组、截肢组均显著增高（P〈0．05）；总体健康较非化疗组显著增高（P〈0．05）；其余各项评分各组比较差异均无统计学意义。结论新辅助化疗联合保肢治疗骨肉瘤合并病理性骨折在保证患者生存率的前提下保存了肢体，并且不增加局部复发率及转移率，还可提高患者的毕存腈骨县治疗骨肉瘤合并病理忡骨析的合理方法．Objective To analyze the curative effect of neoadjuvant chemotherapy combined with limb salvage for osteosareoma with pathologic fracture. Methods The cases were divided into com- bined group （68 cases of osteosareoma with pathologic fracture who received limb salvage after neoadju- vant chemotherapy） , non-chemotherapy group （22 cases of osteosarcoma with pathologic fracture who re- ceived operation without concurrent chemotherapy or chemotherapy only after operation ） , non-fracture group （48 cases of osteosarcoma without synchronous pathologic fracture who received limb salvage after neoadjuvant chemotherapy） and amputation group （32 cases of osteosareoma combined with pathologic fracture who received amputation）. Survival rate, local recurrence rate, metastasis rate and quality of life were compared between groups. Results Average estimated survival period of the combined group was obviously longer than that of the non-chemotherapy group （ P 〈 0.05 ） , but had no significant difference from the non-fracture group or amputation group. Of the 5-year survival rate between groups, the com- bined group was evidently higher than the non-chemotherapy group （ P 〈 0.05 ） , but without significant difference from the non-fracture group or amputation group. Whereas, non-chemotherapy group showed a lower 5-year survival rate than the amputation group or non-fracture group （ P 〈 0.05 ）. Localized recur- rence rate and metastasis rate of the combined group were markedly decreased when compared to the non- chemotherapy group （ both P 〈 0.01 ）, but were not significantly different from the non-fracture group or the amputation group. The combined group showed a significantly higher score of social function than the ampu- tation group （ P 〈 0.01 ） , a significantly higher score of biological pofession than the non-chemotherapy group or the amputation group （P 〈 0.05 ）, and a significantly higher score of general health than the non- chemotherapy group （P 〈 0. 05 ）.

关 键 词：骨折 自发性 骨肉瘤 抗肿瘤联合化疗方案 

分 类 号：R738.1[医药卫生—肿瘤]