瘤段骨酒精灭活再植在恶性骨肿瘤保肢治疗中的临床疗效分析  

Clinical efficacy of alcohol-inactivated autograft replantation in limb savage surgery for malignant bone tumor

作　　者：任晔 龚大伟 陈歌 

机构地区：[1]西南医科大学附属医院骨与关节外科,四川泸州646000

出　　处：《西南医科大学学报》2018年第1期63-66,70,共5页Journal of Southwest Medical University

摘　　要：目的:探讨瘤段骨切除、酒精灭活原位再植重建骨缺损在恶性肿瘤保肢治疗中的疗效。方法:收集2006年11月至2013年12月我院对36例恶性骨肿瘤患者行回顾性分析,男21例,女15例,年龄9~67岁,平均年龄21.4岁。其中Enneking分期ⅡA 14例,ⅡB 22例,术前化疗3周期,采用肿瘤广泛切除,瘤段骨经95%酒精灭活30 min,原位重建骨缺损,锁定钢板内固定行保肢手术。术后2周开始化疗6周期。术后定期随访,行影像学检查观察骨愈合情况及有无肿瘤局部复发。结果:随访时间:13月至82月,平均随访时间52月。ⅡA患者五年期生存率约为71.4%,ⅡB期患者五年期生存率约为63.6%;5例患者出现肿瘤局部复发,复发率13.9%(5/36);13例患者发生肿瘤转移,转移率36.1%(13/36),其中11例肺部转移,2例颅内;术后感染率8.3%(3/36);术后内固定断裂5例,发生率13.9%(5/36);术后骨折不愈合:植入骨吸收1例,骨折延迟愈合7例,不愈合2例,发生率27.8%(10/36);最终获得保肢患者30例,保肢率83.3%(30/36);患者肢体功能均依据Ennecking肢体恶性肿瘤保肢术后功能评价原则:优3例,良8例,可8例,差17例。总优良率52.8%。结论:瘤段酒精灭活再植是一种有效的恶性骨肿瘤保肢手段,联合化疗临床效果满意;肿瘤分期、肿瘤转移、瘤段骨长度是影响术后生存的独立因素。Objective:To evaluate the clinical efficacy of bone tumor resection and alcohol-inactivatedautograft replantation and bone defect reconstruction in limb salvage surgery for malignant bone tumor.Methods:The data of 36 patients with malignant bone tumor who were treated in our hospital between November 2006 toDecember 2013 were reviewed. The 36 patients were comprised of 21 males and 15 females,aged 9-67 years(mean,21.4 years). There were 14 patients with Enneking stage IIA bone cancer,and 22 patients with stage IIBbone cancer. All patients received 3 cycles of chemotherapy prior to limb salvage surgery. Extensive tumor resectionwas performed on the patients,and the resected bone segment was inactivated in 95% alcohol for 30 minutes,followed by orthotopic bone reconstruction and internal fixation with locking plates. The patients received another 6 cycles of chemotherapy at 2 weeks after surgery. All patients were followed up on a regular basis,and bone healingand the presence or absence of local tumor recurrence were determined by imaging examination.Results:Patientswere followed up for a mean of 52 months(13-82 months). The 5-year overall survival rate was 71.4% in stage IIApatients,and 63.6% in stage IIB patients. Tumor recurrence was identified in 5 of the 36 patients(13.9%). Tumormetastases were observed in 13 patients(36.1%),including 11 patients with pulmonary metastases and 2 patientswith brain metastases. The postoperative infection rate was 8.3%(3/36),and the incidence rate of internal fixationbreakage was 13.9%(5/36). Postoperative non-healing bone fracture was identified in 10 patients(27.8%),including 1 patient with bone resorption,7 patients with delayed healing due to bone fracture,and 2 patients with non-healing fractures. A total of 30 patients(83.3%) had successful limb salvage. Based on the Ennekingpostoperative functional evaluation criteria,limb function was excellent in 3 patients,good in 8 patients,general in 8 patients,and poor in 17 patients,and the overall rate of excellence was 52.8%.Conc

关 键 词：酒精灭活 骨肿瘤 骨重建 保肢 

分 类 号：R738.1[医药卫生—肿瘤]