胸骨肿瘤切除钛网重建的初步研究  

Preliminary study of sternal tumor resection and reconstruction with titanium mesh

作　　者：张岩[1] 李甲振[1] 镐英杰[1] 卢新昌[1] 石海龙[1] 刘源[1] 张鹏飞[1] 

机构地区：[1]郑州大学附属第一医院骨科,450052

出　　处：《中华骨科杂志》2014年第11期1145-1150,共6页Chinese Journal of Orthopaedics

摘　　要：目的探讨胸骨肿瘤切除后钛网重建的外科治疗方法、临床疗效及并发症。方法回顾性分析2008年1月年至2012年6月收治8例胸骨肿瘤患者的相关资料，男5例，女3例；年龄37-66岁，平均50．4岁。肿瘤类型包括软骨肉瘤2例、骨肉瘤1例、恶性纤维组织细胞瘤2例、嗜酸性肉芽肿1例、乳腺癌胸骨转移2例。肿瘤侵犯部位包括胸骨柄3例、胸骨柄与胸骨体均有侵犯3例、胸骨体2例。所有患者均经术前穿刺或切开活检明确诊断。8例患者均采用胸骨肿瘤扩大切除、钛网胸廓重建术，嗜酸性肉芽肿患者切除边界为肿瘤缘外2cm，其余病例切除边界均为肿瘤缘外3cm。术后定期门诊复查，主要观察胸廓外观是否出现畸形，钛网有无松动、外露，呼吸运动是否自如，有无呼吸困难、胸闷、胸痛等不适，心、肺功能是否正常，摄胸部X线片观察固定装置是否松动及断裂。结果8例患者均安全完成手术，无术中危象及术中死亡。术后随访9个月~4年。1例术后1周时出现深部血肿，急诊行切开探查，清除血肿，重新放置负压引流，2周后切口愈合。其余病例切口均Ⅰ期愈合，均未出现反常呼吸、皮下气肿、气胸及感染等并发症。1例恶性纤维组织细胞瘤患者术后9个月因肺转移死亡，1例恶性纤维组织细胞瘤术后14个月因肝转移死亡；其余患者随访期间未见肿瘤复发。患者胸廓塑型良好，随访期间钛网无松动、外露，呼吸运动自如，无呼吸困难、反常呼吸、胸闷、胸疼等不适；复查胸部正位x线片示胸廓无畸形，固定装置未见松动及断裂。结论胸骨肿瘤切除后钛网重建胸廓具有塑型效果好、术后并发症少、手术操作简便等优点，钛网是重建胸骨的理想材料。Objective To explore the clinical efficacy and complications of the surgical treatment of sternal tumor resection and titanium mesh reconstruction. Methods From 2008 January to 2012 June, there were 8 cases of sternal tumor patients in our hospital, including 5 male and 3 female, with an average age of 50.4 （37-66） years old. The histological morphology included 2 cases of chondrosarcoma, 1 case of osteosarcoma, 2 cases of malignant fibrous histiocytoma, eosinophilic granuloma in 1 case, and 2 cases of sternal metastasis of breast cancer. Tumor invasion sites included the sternal manubrium in 3 cases, the body in 2 cases, and both in 3 cases. All patients had undergone preoperative puncture or incision biopsy. 8 cases of sternal tumor patients were treated with sternal tumor resection and reconstruction of the thorax using titanium mesh. The clinical effect and complications were retrospectively analyzed. Results All patients were followed up for 9 months to 4 years. The operations went well in all cases, with no intraoperative crisis or operative death. Deep wound hematoma occurred in 1 patient 1 week postoperatively, who healed 2 weeks after drainage and debridement. There was no abnormal breathing, subcutaneous emphysema, pneumothorax, infection or other complications in other cases. 1 case of malignant fibrous histiocytoma died of lung metastasis at 9 months follow-up, and 1 died of liver metastasis at 14 months, while other patients got no tumor recurrence, with good thoracic shape, free breathing, no titanium mesh loosening, dyspnea, chest tightness, pain, or abnormal respiratory discomfort during follow-up period. The chest radiograph showed no chest deformity, no loosening or fracture of the fixation device. Conclusion Sternal tumor resection and reconstruction with titanium mesh has the advantages of good shaping effect, fewer complications, and simple operation, showing that titanium mesh is an ideal material for the reconstruction of sternum.

关 键 词：胸骨 骨肿瘤 钛 修复外科手术 

分 类 号：R738.1[医药卫生—肿瘤]