四肢长骨恶性肿瘤并发骨折手术时机及方法.docVIP

四肢长骨恶性肿瘤并发骨折手术时机及方法 　 作者： 李东升，张志勇，黄满玉，冯 峰，古建立 【关键词】 病理骨折 摘 要：［目的］探讨四肢长骨恶性肿瘤并发骨折的手术时机及手术方法。［方法］回顾1996年6月～2003年10月收治的四肢长骨恶性肿瘤并发骨折17例，其中骨肉瘤4例，骨巨细胞瘤3例，尤文氏肉瘤1例，造釉细胞瘤1例，骨转移瘤8例。采用Ⅰ期外固定并化疗，Ⅱ期瘤段切除重建术4例；Ⅰ期行肿瘤病灶清除功能重建术11例；Ⅰ期截肢1例，Ⅱ期截肢1例。［结果］随访时间12～88个月，原发性恶性肿瘤9例中，肺转移死亡2例，其中1例局部复发；骨转移瘤8例中，死亡4例，其中1例局部复发。［结论］化疗敏感的原发恶性肿瘤并发骨折主张优先考虑Ⅰ期外固定并化疗，Ⅱ期瘤段切除重建；化疗不敏感的骨巨细胞瘤及骨转移瘤并发骨折应Ⅰ期行病灶清除功能重建。 关键词：骨肿瘤； 四肢长骨；病理骨折； 治疗/外科手术 Abstract：［Objective］To study the methods and opportunity of operation for the malignant tumor intercurrent fracture of extremity［Method］Seventeen cases of malignant tumor intercurrent fracture of extremity were reviewed in our hospital from June 1996 to October 2003 in the study,which included osteosareoma 4 cases,giant cell tumor 3 cases,ewing tumor 1 case,ametoblastoma of bone Ⅰ case,bony metastases 8 eases4 cases treated with exterior fixation and chemotherapy in Ⅰ P（period）and reconstruction alter tumor cutting in ⅡP（period）,11 cases treated tumor eliminate and reconstruction in Ⅰ P（period）One case amputed in Ⅰ P（period）and 1 case amputed in Ⅱ P（period）［Result］All patients treated had been followed up from 12 to 88 monthsOne case occurred local rccurrreneeand 2 cases died because of lung metastases in the 9 cases of primary malignant tumorWhile 1 case occurred local reecurrenee and 4 cases died in the 8 cases of metastasis malignant tumor［Conclusion］For the primary,malignant tumors with fracturewhich were sensitive to chemotherapy,should first take into account to exterior fixation and chemotherapy inⅠ P（period）and reconstruction after tumor cutting in ⅡP（period）,while for the insensitive giant cell tumor and bony metastases with fracture should be treated with tumor eliminate and reconstruction in ⅠP（period） Key words：Bone tumor; Extremity long bone; Pathological fracture; Fracture; Therapy/Surgery 四肢长骨发生肿瘤后，由于负重或外力作用常常造成病理骨折，其治疗难度增大。不同的外科处理方法，预后差别较大，不恰当的处理可能导致严重后果。1996年6月～2003年10月，本院收治各类并发骨折的四肢长骨恶性肿瘤17例，根据肿瘤性质和骨折类型等，采用不同的治疗方法。本文通过回顾性分析，探讨骨恶性肿瘤并发骨折后的手术时机、手术方法。 1 临床资