保留皮质扩大切除及重建术治疗四肢侵袭性骨肿瘤.docVIP

保留皮质扩大切除及重建术治疗四肢侵袭性骨肿瘤 　 作者：彭庄，陆晴友，席秉勇，尹峰，李增春，蔡俊丰 【摘要】 ［目的］探讨保留皮质的扩大切除与重建术的临床应用及疗效。［方法］12例侵袭性骨肿瘤患者男6例，女6例；平均年龄37.1岁。根据MRI表现选择不同截骨方法，Ⅰ型肿瘤位于干骺端偏心性生长，采用保留一侧皮质骨的肿瘤外截骨，截骨线呈“匚”形。Ⅱ型病例肿瘤侵蚀部分关节面，采用保留一侧皮质的部分关节截骨，截骨线呈“L”形。Ⅲ型病例肿瘤侵蚀整个关节面和骨皮质，可切除包括关节在内的整个瘤段骨，只是近骨干侧截骨呈阶梯状。［结果］手术时间1～3 h，术中出血量150～400 ml，术后切口一期愈合。12例患者获6个月～8年随访。按ISOLS评分标准评价肢体功能恢复情况：上肢平均22.3分，下肢平均25.3分。灭活回植骨、异体骨与截骨端平均3个月愈合，局部复发1例，复发率7.69%。无恶性变及全身转移。［结论］保留皮质的扩大切除与重建术可提高四肢侵袭性骨肿瘤的治疗效果；严格掌握适应证、无瘤无菌操作、彻底灭活瘤壳和截骨端是降低复发率的关键。 【关键词】 保留皮质重建术； 骨肿瘤； 侵袭性 Abstract：［Objective］To investigate the clinical application and therapeutic effect of reservation cortical expand resection and reconstruction for extremities bone tumor.［Method］Twelve cases with extremities invasion bone tumor were reviewed,including 6 male and 6 female.The average age was 37.1 years old.According to the MRI,TypeⅠtumor located in metaphysic and growth eccentricity,and was treated with outside tumor osteotomy with reservation of one side as integumentale,the cut line was shape of “匚”.Type Ⅱ tumor was with invasion part articular surface,and was operated with part joint osteotomy with reservation of one side as integumentale,the cut line was shape of“L”.Type Ⅲ was with invasion total joint surface and as integmentale,all tumor segment including joint could be cut,but the shape of cut close to the diaphysis was echelonment.［Result］The operation time was 1～3 h,the operative bleeding quantity were 150～400 ml,all incisions were obtained primary healing.Twelve cases were followed up from 6 months to 8 years.The average extremity functional score according to the system of ISOLS（International Society of Limb Salvage）:upper extremity was 22.3 and the lower was 25.3 The average bone healing time of returned deactivation bone graft and bone allograft healing with the osteotomy plane was 3 months,original tumor recurrence in local was 1,the recurrence rate was 7.69%,no malignant change and metabasis was found.［Conclusion］The reservation cortical expand resection and reconst