定制型节段假体重建长骨骨干转移瘤骨缺损

目的探讨定制型节段假体重建治疗长骨骨干转移瘤骨缺损的临床效果。方法应用定制型节段假体重建治疗15例长骨骨干转移瘤骨缺损患者。采用Kaplan-Meier法计算患者生存率,NRS评分评估术后疼痛,MSTS 93评分系统评估术后肢体功能。结果8例存活,随访时间16~56(29.75±13.20)个月;7例死亡,随访时间12~44(23.86±12.24)个月。术后1年患者总生存率93.3%,术后2年患者总生存率73.3%。假体在体时间12~56(27.00±13.10)个月,假体长度6~13(9.73±2.15)cm。术后3个月MSTS评分24~29(26.87±1.55)分。NRS评分术前4~8(6.20±1.15)分,术后1个月0~1(0.20±0.40)分,差异有统计学意义(P<0.05)。1例肱骨转移瘤患者术后6个月复查出现影像学无菌性松动,未明显影响上肢功能。结论定制型节段假体重建长骨骨干转移瘤骨缺损具有缓解疼痛明显、允许早期负重及功能锻炼、保留较好肢体功能、术后并发症发生率较低等优势。     

Are Cemented Endoprosthetic Reconstructions Superior to Uncemented Endoprostheses in Terms of Postoperative Outcomes and Complications in Patients with Extremity-Located Bone Metastasis Scheduled for Adjuvant Radiotherapy?

BackgroundAdjuvant radiotherapy frequently is used for prevention of recurrence following resection and endoprosthetic reconstruction of bone metastases. Besides this positive effect, radiotherapy can negatively affect both cemented and uncemented endoprostheses.MethodsWe retrospectively analyzed 130 extremities of 115 patients who underwent resection and cemented or uncemented endoprosthetic reconstruction for bone metastasis, followed by postoperative radiation therapy. The functional improvement was assessed by Karnofsky Performance Scale and Musculoskeletal Tumor Society (MSTS) scoring. The radiological evaluation mainly included analysis of “loosening areas” which were defined as the regions of osteolysis between the stem of the endoprostheses and the cement or cortex. The complications resulting in reconstruction failure and patient survival were recorded.ResultsA survival analysis revealed that 21 (18.3%) patients were alive with disease and 94 (81.7%) died of disease at the time of study. The mean last follow-up Karnofsky Performance Scale and MSTS scores of the whole study cohort were 78.69 ± 8.66 and 82.15 ± 9.06, respectively. There were 8 (6.15%) complications resulting in reconstruction failure, including aseptic loosening (2), femoral stem breakage (2), periprosthetic fracture (2), and infection (2). The number and time of complications did not show a significant difference between the cemented and uncemented groups (P > .05).ConclusionThis study demonstrated that there was no significant difference in complication rates of cemented or uncemented endoprosthetic reconstructions in patients with extremity-located bone metastases scheduled for adjuvant radiotherapy. The only result in favor of cemented prostheses was significantly higher MSTS functional scores at last follow-up.     

定制节段人工假体复合结构骨移植重建骨干肿瘤术后大段骨缺损的临床研究

目的 评价应用定制节段型人工假体复合大段结构骨移植重建骨干恶性肿瘤切除术后骨缺损的临床疗效。方法 回顾性分析我院骨肿瘤科2014年1月至2019年3月期间,采用定制节段型人工假体复合大段结构骨移植重建骨干恶性肿瘤切除术后骨缺损的病人共6例（股骨3例,胫骨2例,肱骨1例）,其中2例采用大段冻干异体骨,4例采用自体游离腓骨结构植骨。采用美国骨肿瘤学会评分系统（Musculoskeletal Tumor Society 93, MSTS 93）评价术后功能。结果 所有病人均未发生围手术期并发症,且均获得随访,平均随访时间为23.8个月（1~61个月）。术后根据肿瘤性质继续辅助化疗等治疗,随访期内无复发,5例无瘤生存,1例死于原发乳腺癌肺转移（术后25个月）,假体生存率为100%,4例术后6个月植骨愈合,术后MSTS 93评分平均为27分。结论 规范治疗和切除骨干恶性肿瘤后,采用定制节段型人工假体复合大段骨移植重建骨干骨缺损,实现即刻稳定重建,保留关节功能,中期植骨愈合后实现远期生物重建,并发症少,临床疗效满意。     

髋臼周围恶性骨肿瘤的切除与重建

背景：累及髋臼的恶性肿瘤由于位置较深,毗邻重要的血管神经和内脏器官,因而切除困难。切除后如何恢复骨盆连续性和髋臼功能的方法仍需完善。目的：探讨累及髋关节恶性肿瘤切除和重建的方法和效果。方法：回顾性研究2004年1月至2010年12月22例累及髋臼的骨盆恶性肿瘤的切除和重建,分析患者的生存、肿瘤复发和转移、术后并发症,并利用MSTS评分系统对患者的功能进行评估。结果：全部获得随访,随访时间为7.1～84.3个月,平均37.0个月。15例无病生存,5例死于肿瘤复发和转移,2例带瘤生存。7例患者出现局部复发,局部复发率为31.82%,术后复发间期为3.0～41.2个月,平均17.1个月。4例患者发生肿瘤肺转移,术后转移间期为5.8～38.1个月,平均16.6个月。术后6个月的MSTS功能评分为32.5%～83.7%,平均68.6%。结论：对累及髋臼的恶性骨肿瘤进行广泛性切除并根据骨缺损的程度选择不同类型的组配式假体重建可以获得较好的疗效和功能。     

Endoprosthetic reconstruction using total femoral custom mega prosthesis in malignant bone tumours

We analysed 17 patients with primary malignant bone tumour of the femur who underwent limb salvage surgery with the total femoral custom mega prosthesis during the period 1994–2008. The patients were in the age group of 12–73 years, with a mean age of 30.94 years. There were 14 males. The most common diagnosis was osteosarcoma. The average follow-up period was 54.05 months with the longest being 168 months. The average Musculoskeletal Tumour Society (MSTS) functional score was 66.6%. The two- to 14-year overall survival was 82.4%. Three patients died of disease and one patient required amputation. Complications encountered were deep infection and dislocation of the prosthesis.     

酒精灭活瘤段骨复合假体治疗膝关节周围骨巨细胞瘤的中期随访研究

 目的 探计膝关节周围骨巨细胞瘤整块切除,酒精灭活瘤段骨复合假体重建的手术技术及预后。方法 2007年1月至2008年10月,对8例膝关节周围Campanacci Ⅲ级骨巨细胞瘤患者采用肿瘤整块切除,酒精灭活瘤段骨复合假体重建,男5例,女3例;年龄20~40岁,平均31岁。股骨远端5例,胫骨近端3例。4例为原发肿瘤、余4例为复发病例,其中2例伴有病理性骨折。术后根据国际骨肿瘤协会(Musculoskeletal Tumor Society, MSTS)“骨与软组织肿瘤术后功能重建的评估标准”进行肢体功能评估。根据国际保肢学会(International Society of Limb Salvage,ISOLS)影像评分标准(复合移植)进行影像学评估。结果 随访38~67个月,平均54个月,未出现复发、转移、假体松动等。灭活骨与宿主骨平均愈合时间5.5个月。随访末期,MSTS评分为25~29分,平均为26.3分(88%),ISOLS复合移植评分为28~35分,平均为32.8分 (88.5%)。1例术后3个月局部疼痛,X线片显示宿主骨-灭活骨有轻微骨吸收,非负重功能锻炼,术后6个月复查骨吸收消失。“爬行替代”可能是酒精灭活骨复合假体重建的主要骨愈合方式,股骨病例的愈合时间略快于胫骨病例。结论 对于膝关节周围Campanacci Ⅲ级骨巨细胞瘤,采用整块切除并酒精灭活瘤段骨复合假体重建可以取得满意的临床效果。     

The Efficacy of Radiofrequency Ablation for Bone Tumors Unsuitable for Radical Excision

BackgroundBone tumors can cause severe pain and poor quality of life due to recurrence and non-achievement of complete remission after surgery, chemotherapy, or radiotherapy. Radiofrequency ablation (RFA) can be considered for minimally invasive treatment of bone tumors that are difficult to radically excise. In this study, RFA was performed for bone tumors that were difficult to radically excise and did not respond to surgery, chemotherapy, or radiotherapy due to their large sizes and/or locations. The purpose of this study was to retrospectively analyze the clinical characteristics and survival rates of bone tumors after RFA and provide one more treatment option for the future.MethodsThere were 43 patients with bone tumors who underwent percutaneous RFA at our hospital from April 2007 to October 2017. The median age of the patients was 59 years (range, 31–75 years), and the median follow-up duration was 67.2 months (range, 10.2–130.5 months). Of the 43 patients, 26 were male and 17 were female. Thirty-four cases were metastatic bone tumors, 5 were chordomas, 3 were osteosarcomas, and 1 was a giant cell tumor. Pain and functional ability of the patients were evaluated using a visual analog scale (VAS) and the Musculoskeletal Tumor Society (MSTS) functional scoring system, respectively. Scores were recorded preoperatively, 1 week postoperatively, and 4 weeks postoperatively. The 1-year, 2-year, and 5-year survival rates were evaluated using the Kaplan-Meier method.ResultsThe mean VAS score was 8.21 preoperatively. The mean VAS score at 1 week, 4 weeks, 12 weeks, and 24 weeks postoperatively were 3.91, 3.67, 3.31, and 3.12, respectively. The mean preoperative MSTS score was 64.0% (range, 32%–87%). The mean postoperative MSTS score was 71.0% (range, 40%–90%). The 1-year, 2-year, and 5-year survival rates were 95.3%, 69.8%, and 30.2%, respectively.ConclusionsAs per our study findings, RFA was effective in reducing pain and improving functional ability of patients with bone tumors that were difficult to radically excise.     

肿瘤型人工关节重建下肢骨肉瘤切除后的骨缺损

目的总结应用肿瘤型人工关节重建下肢骨肉瘤切除后骨缺损的效果及并发症。方法1997年7月~2004年7月共对167例下肢骨肉瘤实施广泛性切除后人工假体重建保肢术,100例获得随访。其中男56例,女44例。年龄13~57岁。股骨近端5例,股骨远端57例,胫骨近端38例。Enneking分期A期3例,B期85例,期12例。使用国产假体71例,进口假体29例。17例患者采用灭活肿瘤骨结合人工假体复合重建缺损,21例采用异体骨人工关节复合体,余62例采用人工假体进行重建。所有成骨肉瘤患者术前均行1~2个疗程规范化疗,术后3~5个疗程化疗。术后采用MSTS保肢评分系统对随访患者进行功能评价。结果所有患者获随访1~8年,中位随访时间3.5年。人工关节3年生存率为81.8%,5年生存率为65%。6例假体折断,13例假体迟发性感染,2例假体松动,5例移植物与宿主骨接合处不愈合,2例异体骨吸收,2例假体下沉,1例骨折。7例于术后6个月~2年内肿瘤局部复发,其中软组织肿瘤复发4例,接受肿瘤再切除治疗;另3例接受截肢手术。患者MSTS评分平均为23.30±5.17。肢体功能优62例,良27例,中7例,差4例,优良率为89%。结论与其他保肢重建方法比较,肿瘤型人工关节能保留最好的关节功能。但并发症发生率仍较高,人工关节的设计及加工有待于进一步改进。     

Clinical effectiveness of hemipelvic reconstruction using computer-aided custom-made prostheses after resection of malignant pelvic tumors

This is a retrospective analysis of 16 patients with primary malignant pelvic tumors who underwent wide resection of the hemipelvis and consequent reconstruction between 2003 and 2007. Mean patient age was 27 years, whereas median follow-up was 36 months (range, 23-62 months). Hemipelvic prostheses were individually designed for each patient based on preoperative computed tomographic scans and consequent surgical modeling. The 3-year prosthesis survival rate was 69%. There were 3 cases of local recurrence (19%), and 4 patients died because of pulmonary metastases. The mean follow-up Musculoskeletal Tumor Society functional score was 72%. In conclusion, computer-aided custom-made hemipelvic prosthesis can be applied to quickly and effectively restore the bone defect after internal hemipelvectomy for treatment of pelvic tumors.     

Limb sparing surgery for bone tumours of the shoulder girdle: the oncological and functional results

It is a great challenge to spare the upper limb with a malignant or invasive benign bone tumour of the shoulder girdle. We retrospectively analysed 35 patients with bone tumours of the shoulder girdle treated with various limb salvage procedures. The tumours included 25 primary malignancies, three metastases and seven giant cell tumours which involved the proximal humerus in 21 patients, scapula in 12 and clavicle in two. The reconstruction procedures included eight prosthetic replacements, four devitalised tumorous bone grafts, three osteoarticular allografts, two autogenous fibular grafts, one intramedullary cemented nail, three Tikhoff-Linberg procedures, two replantation of shortened arms, and four humeral head suspensions. Six partial scapulectomies and two lateral clavicectomies needed no bone reconstruction. With an average follow-up of 71 months, local recurrences occurred in four cases and systemic metastases in six. Nine patients died and 23 remained disease free. The five year Kaplan-Meier survival rate of 28 patients with malignancies was 69.5%. The average Musculoskeletal Tumour Society (MSTS) functional score was 77% (range 40–100%) in all patients.     

定制人工假体置换治疗股骨近端骨肿瘤

目的评价定制人工假体置换治疗股骨近端骨肿瘤的疗效。方法对股骨近端骨肿瘤30例行瘤段切除、定制人工假体置换治疗。其中21例行加长柄双动性股骨头置换,9例行加长柄全髋置换。术后6个月功能评价采用MSTS 93评分。结果 30例均获随访,时间12～36个月。无感染、假体松动、假体脱位、假体周围骨折等并发症发生。术后6个月MSTS 93评分平均为(26.0±2.14)分;肢体功能:优15例,良12例,中3例,优良率为90%。2例于术后13、15个月死亡。结论定制人工假体置换是治疗股骨近端骨肿瘤的有效方法,术后髋关节功能良好。     

肿瘤型假体重建膝关节周围原发性肿瘤切除后骨缺损

目的总结膝关节周围原发性骨肿瘤保肢手术中人工关节重建的疗效和并发症。方法回顾性分析我院1995年12月至2005年12月83例应用肿瘤型假体重建膝关节周围骨肿瘤切除后骨缺损的临床资料。其中骨肉瘤58例,多中心骨肉瘤2例,皮质旁骨肉瘤1例,恶性纤维组织细胞瘤4例,骨巨细胞瘤13例,平滑肌肉瘤1例,尤文肉瘤2例,软骨肉瘤2例。根据骨缺损重建部位分组：股骨下端组44例,胫骨上端组34例,全股骨置换组5例。结果所有患者均获得随访,随访时间12～130个月,平均41个月。局部复发6例,2例晚期感染,假体松动2例,无假体断裂;假体3、5年生存率分别为88．2％、82．1％。41例植骨患者形成皮质外骨桥。肢体肌肉骨骼肿瘤外科治疗重建术后功能评分：股骨下端组19．0—29．0分,平均25．0分;胫骨上端组17．0—28．0分,平均24．4分;全股骨置换组16．0—21．0分,平均19．0分。股骨下端组和胫骨上端组功能优于全股骨置换。结论肿瘤型人工关节重建膝关节周围骨肿瘤并发症发生率低,关节功能良好。     

Modulare Tumorprothesen des Humerus

The humerus is a common location of musculoskeletal tumors. Modular prostheses of the humerus, besides APC and biological reconstructions, allow restoration of resulting bone defects. The functional outcome is determined by the extent of bone and soft tissue loss. Anatomical shoulder prostheses have a limited abductor function, while shoulder function could be improved by an inverse prosthetic design and implants for ligament repair. Elbow prostheses provide satisfactory function. Our own results in 101 patients showed a 23% revision rate. The median overall survival was 171 months with an overall 5-year survival of 53%. With respect to good oncological outcomes modular reconstruction of the humerus is a feasible treatment option for cancer patients.     

血管重建在骨与软组织肉瘤保肢术中的应用

目的 探讨血管重建在骨与软组织肉瘤保肢术中的作用.方法 2004年8月至2009年6月累及肢体重要血管的骨与软组织肉瘤患者13例接受保肢手术,男8例,女5例;年龄14～63岁,平均38岁.恶性骨肿瘤4例,软组织肉瘤9例.1例位于肱骨上端,12例位于下肢.7例同时重建动脉和静脉,6例仅重建动脉.5例采用同侧或对侧大隐静脉移植,8例采用人工血管置换.结果 无一例出现重建血管感染.1例肱骨骨肉瘤行肱动脉人工血管置换的患者于术后第1天出现急性动脉栓塞,急诊取栓后保留了肢体.人工血管置换8例中出现肢体肿胀和伤口不愈合5例,大隐静脉移植5例伤口均一期愈合.全部患者随访7～45个月,平均19.4个月.1例肱骨骨肉瘤患者术后12个月出现局部复发,保肢成功率92.3%(12/13).1例术前肺转移患者于术后7.5个月死于肺转移,另4例患者于术后半年至1年出现肺转移.Kaplan-Meier生存曲线分析患者2年总生存率和无瘤生存率分别为90.9%和63.6%,重建动、静脉2年通畅率分别为100%和28.6%.12例下肢肿瘤患者末次随访时的1993年美国骨肿瘤学会评分系统评分平均为72%,肱骨骨肉瘤患者为33%.结论 肿瘤累及血管不是截肢的绝对适应证,肿瘤连同重要血管整块切除后进行血管重建的保肢手术可行,可获得良好的局部肿瘤控制和肢体功能.

Abstract：

Objective To determine the feasibility of limb salvage with major vascular reconstruction for sarcomas of extremities, focusing on the early complications, oncological and functional outcomes.Methods Between August 2004 and June 2009, 13 patients (mean age 38 years, range 14-63 years) underwent wide resection of upper and lower extremity sarcomas to include the involved arterial and venous segments. 4 patients had bone sarcomas and 9 soft tissue sarcomas, 6 patients only had underwent artery replacement and the other 7 had underwent both artery and vein. 8 resected vessels were reconstructed with vascular graft and 5 with ipsilateral or contralateral saphenous vein. Results No patient suffered from reperfusion injury and infection. The patient with osteosarcoma in proximal humerus had suffered acute arterial graft thrombosis at first day postoperatively; however, the limb was salvaged after successful thrombectomy. 5 of 8 patients with synthetic graft developed minor delayed wound healing and hematoma, but the other 5 patients with autologous saphenous vein replacement did not. The mean follow-up was 19.4 months (7-45months). One patient died of pulmonary metastasis; the patient with osteosarcoma in proximal humerus had developed local recurrence, but refused amputation and was alive with metastasis. No arterial occlusion was observed at final follow-up or at the time of death, but the patency of artery and vein was 100% and 28.6%respectively. One patient who has pulmonary metastases before operation died of metastases 7.5 months after operation. Four patients developed pulmonary metastases, therefore, Kaplan-Meier survival analysis showed that 2-year overall and metastasis-free survival rate was 90.9% and 63.6% respectively. Functional status were judged as good or excellent (mean MSTS score 72%) in 12 of 13 patients. Conclusion The study indicate that malignant involvement of major vessels is not a contraindication for limb-salvage. Vascular reconstruction is a feasible option in limb salvage surgery. Wide resection with vascular reconstruction provide acceptable oncological and functional outcome of limb salvage.     

骨盆骨肉瘤的外科治疗策略探讨

目的 探讨手术治疗骨盆骨肉瘤的切除及重建方式.方法 回顾性分析2000年6月至2009年6月接受肿瘤切除重建手术的21例骨盆骨肉瘤患者的病例资料.其中男性12例,女性9例;平均年龄30岁.肿瘤累及范围:Ⅰ区3例,Ⅰ+Ⅳ区3例,Ⅰ+Ⅱ区4例,Ⅱ+Ⅲ区4例,Ⅰ+Ⅱ+Ⅲ区1例,Ⅲ区1例,Ⅰ+Ⅱ+Ⅳ区5例.其中经典骨肉瘤19例,高分化骨肉瘤2例.21例均为ⅡB期.所有病例均行整块切除,外科边界为13例广泛切除,8例边缘切除.重建方式包括:可调式人工半骨盆假体重建13例;自体骨移植+钉棒系统重建5例;半骨盆截肢2例;单纯切除1例.患者术后平均随访时间30.3个月(6.0～87.0个月).结果 21例患者中13例存活,总体生存率为61.9%,无瘤生存率23.8%;5年生存率为44.2%.局部复发率为28.6%(6/21),其中累及Ⅱ区肿瘤复发4例(4/13),Ⅰ区肿瘤复发1例(1/3),Ⅰ+Ⅳ区肿瘤复发1例(1/3),Ⅲ区肿瘤单纯切除的1例患者及2例半骨盆截肢患者未发生局部复发.肿瘤广泛切除术后复发率为23.1%(3/13),边缘切除术后复发率为37.5%(3/8).9例患者术后出现肺转移(42.9%),1例患者发生骨及淋巴结转移.13例存活患者MSTS 93功能评分为(20.6±5.4)分.4例自体骨移植+钉棒系统内固定患者功能评分为(22.5±2.1)分;7例町调式人工半骨盆重建患者,于术后8周开始扶拐行走,半年后可去拐行走,功能评分为(17.7±5.5)分.结论 选择合适的切除与重建方式,多数骨盆骨肉瘤患者可以行保肢治疗,可保留部分肢体功能.     

下肢远端原发恶性骨肿瘤患者的生存和肢体功能分析

目的 分析下肢远端原发恶性骨肿瘤患者的生存情况,评估保肢后的肢体功能.方法 2003年11月至2010年1月,20例下肢肢体远端原发恶性骨肿瘤接受保肢或截肢手术.男性15例,女性5例,平均年龄20岁.肿瘤位置:胫骨远端14例,腓骨远端3例,跟骨3例.肿瘤分期:ⅠB期3例,ⅡB期16例,Ⅲ期1例.除3例胫骨下端肿瘤截肢外,其他11例胫骨远端肿瘤行自体骨(4例)或异体骨(7例)踝关节融合手术,6例腓骨远端和跟骨肿瘤行自体骨重建手术.平均随访36.4个月.结果 5例异体骨踝关节融合和1例跟骨自体骨重建患者伤口延迟愈合,自体骨和异体骨对伤口愈合的影响差异有统计学意义(P=0.036).2例异体骨出现吸收和不愈合(其中1例截肢,另1例更换为骨水泥临时假体),1例胫骨远端骨肉瘤术后11个月复发截肢,2例分别于确诊后22和48个月死于肺转移.患者2和5年的总生存率分别为92.9%和79.6%,12例高度恶性骨肉瘤的2和5年生存率分别为87.5%和70.0%.保肢患者功能MSTS评分为82%.结论 下肢肢体远端原发恶性骨肿瘤的整体生存情况相对较好,保肢可以获得良好的肿瘤控制和肢体功能.     

Reconstruction of the proximal femur with a modular resection prosthesis

Background

Various megaprostheses are currently available for reconstruction of the proximal femur after tumor resection. This study evaluates the survival and complications of a modular megaprosthesis for reconstruction of the proximal femur.

Materials and methods

We studied the medical files of 109 tumor patients (age range 16–86 years) who underwent proximal femoral reconstruction with the MRP^® megaprosthesis from 2002 to 2011. There were 70 patients with metastases, 34 patients with bone sarcomas, and five patients with hematological malignancies; 82 were primary and 27 were revision reconstructions. Mean follow-up was 2.5 years; 31 patients had a minimum five-year follow-up. We evaluated the survival and function of the patients, and the survival and complications of the megaprostheses.

Results

Survival was significantly higher for the patients with bone sarcomas compared to those with metastases and hematological malignancies. Mean MSTS functional score was similar between patients with bone sarcomas and those with hematological malignancies and metastases, and between patients with primary and those with revision reconstructions. Overall survival of the MRP^® megaprostheses was 74 % at 5 and 9 years. Fourteen (13.6 %) major complications occurred at a mean period of 1.4 years (range 3 months to 4.5 years); these included infection (5.8 %), dislocation (3.9 %), local recurrence (2.9 %), and acetabular fracture (1 %).

Conclusion

MRP^® megaprostheses are a valuable reconstruction option after tumor resection of the proximal femur.

     

Intercalary endoprosthetic reconstruction for impending pathological fractures in patients with femoral diaphyseal bone metastases

Improvement of the life expectancy in patients with metastatic bone tumors has increased the emphasis on preserving the function of affected limb. Between 2006 and 2008, we used custom-made endoprostheses in four patients to reconstruct femoral diaphyseal defects after excision of metastatic bone tumors. The mean age at operation was 65 years (55–78) and the median follow-up 10 months (4–17). Using the Musculoskeletal tumor society (MSTS) functional scoring system, the mean MSTS functional score was 67%. Local recurrence and mechanical loosening were not occurred. We conclude that diaphyseal endoprostheses in femoral bone offer a good clinical and functional outcome.     

微波消融联合骨水泥、锁定钢板内固定治疗长骨干转移癌

目的探讨原位微波消融联合骨水泥、锁定钢板内固定治疗四肢长骨干转移癌的疗效。方法回顾性分析2010年3月~2018年6月我科收治的17例四肢长骨干转移癌患者的临床资料,其中病理性骨折3例,均采用原位微波消融、病灶刮除后联合骨水泥填充、锁定钢板内固定治疗,手术部位:股骨7例,肱骨6例,胫骨4例。结果所有患者均顺利完成手术,无术中并发症。所有患者术后均获得随访,随访时间5~27个月。术后3月VAS评分、MSTS评分、KPS评分较术前明显改善,差异均有统计学意义(P<0.05)。术后14个月出现右股骨钢板断裂并骨折1例,术后20个月出现左肱骨转移灶复发1例。随访期间死亡12例,存活5例。术后半年、1年及2年生存率分别为94.1%,60.8%及8.9%。结论采用原位微波消融联合骨水泥填充、锁定钢板内固定治疗四肢长骨干转移癌,可以降低肿瘤局部复发率,缓解疼痛,恢复患肢功能,改善患者生活质量。