微波灭活髓内钉固定治疗长骨骨干转移瘤的疗效观察  

The efficiency of in situ microwave ablation combined with intramedullary interlocking nail on limb diaphyseal metastases

作　　者：李嘉[1] 姬文晨[1] 阮之平[2] 韩学哲[1] 杨益民[1] 戴星[1] 李萌[1] 

机构地区：[1]西安交通大学第一附属医院骨科,西安710061 [2]西安交通大学第一附属医院肿瘤内科

出　　处：《山西医科大学学报》2017年第11期1182-1185,共4页Journal of Shanxi Medical University

基　　金：国家临床重点专科建设资助项目

摘　　要：目的探讨微波原位灭活病灶刮除骨水泥填充加交锁髓内钉固定的方法治疗长骨骨干转移瘤的疗效。方法收集2009-01~2014-06西安交通大学第一附属医院收治的四肢长骨骨干转移瘤23例(23处),均采用微波原位灭活、病灶刮除、骨水泥填充加交锁髓内钉固定的方法治疗,其中20例伴有病理性骨折。术前术后分别采用视觉模拟评分(VAS)评价疼痛程度,Enneking评分评价肢体功能,Karnofsky评分评价生活质量。结果全部病例均获随访,时间4-24个月,平均16.2个月。手术顺利,无术中死亡病例,术后切口均一期愈合。局部复发1例,无感染病例。无骨水泥及髓内钉松动、断裂等情况发生。随访期间死亡14例,存活9例,总体半年生存率91.3%,1年生存率69.6%,2年生存率39.1%。术后视觉模拟评分、Enneking评分、Karnofsky评分较术前均有改善。结论采用瘤段微波原位灭活、病灶刮除、骨水泥填充加交锁髓内钉固定的方法治疗长骨骨干转移瘤,可以恢复患者的完全负重能力,减轻疼痛,提高生存质量,是一种有效的外科治疗方法。Objective To evaluate the efficiency of in situ microwave ablation,clearance of focal lesion,cement infilling combined with intramedullary interlocking nail on limb diaphyseal metastases. Methods Twenty-three patients with limb diaphyseal metastases were treated with in situ microwave ablation,clearance of focal lesion,cement infilling combined with intramedullary interlocking nail from January 2009 to June 2014 in the First Affiliated Hospital of Xi＇an Jiaotong University. Of 23 patients,20 patients were accompanied by pathological fractures. The visual analogue scale（ VAS） score before operation and 3 months after operation were investigated.In addition,Enneking score and Karnofsky performance scale were assessed. Results All of the 23 patients were followed up for 4-24 months with the average follow-up period of 16. 2 months. All the operations were successful without patient death during the operation and all incisions achieved primary healing. One case of local recurrence was observed and there were no complications including infection,loosening or breakage of internal fixation. During the follow-up period,14 patients died. The postoperative 6-month,1-year and 2-year survival rates were 91. 3%,69. 6% and 39. 1%,respectively. The VAS score,Enneking score and Karnofsky performance scale were all improved. Conclusion In situ microwave ablation,clearance of focal lesion,cement infilling combined with intramedullary interlocking nail is an effective method to treat patients with limb diaphyseal metastases. It could relieve the patients＇ pain and restore the limb function.

关 键 词：骨转移瘤 微波 髓内钉 外科治疗 

分 类 号：R738[医药卫生—肿瘤]