下肢远端恶性肿瘤的保肢治疗

目的评估下肢远端恶性肿瘤的治疗效果。方法回顾性研究澳大利亚昆士兰州骨肿瘤中心43例小腿远侧1/3或足踝部恶性肿瘤的患者,评估术后生存率(时间)肿瘤复发率、保肢后肢体功能以及并发症等。结果43例患者平均随访时间50个月,生存率为74.4%(32/43),34例进行了保肢手术,其中有2例复发(占保肢手术的5.9%)。根据骨与软组织肿瘤协会(MusculoskeletalTumorSociety,MSTS)功能评判系统对患者进行量化的患肢功能评估。在27例保肢术的患者中,平均功能评分为82.7%,86.2%(25/29)的患者在保肢术后,其末端肢体保持着正常或者较好的功能。结论在大多数下肢远端恶性肿瘤的患者中,应用广泛切除联合小区域的边缘切除、软组织皮瓣和功能性重建,同时辅助放疗和化疗的综合方案,可以降低保肢术后的复发率,提高疾病的痊愈率,降低并发症以及保留足部的感觉和负重功能。

Functional Limb Salvage for Malignant Tumors of Lower Distal Extremities

Objective Malignant tumors of lower distal extremity are uncommon and the treatment is still controversy. Methods Forty-three patients were studied retrospectively with respect to survival, local recurrence, functional limb preservation and complication. Results After a median follow-up of fifty months, the survival rate was 74.4% (32/43). Thirty-four patients had limb salvage operations, two of them (5.9%) had local recurrence. The functional results were assessed quantitatively according to the functional rating system of the Musculoskeletal Tumor Society. Functional score was 82.7% in average for limb salvage surgery in twenty-seven patients. Ultimately, 86.2% (25/29) patients retained a normal or fairly normal extremities after limb salvage operation. Conclusions In most patients, wide resection, accepting focally marginal margins together with adjuvant radiation, chemotherapy and soft tissue flap reconstruction can lead to a limb salvage procedure with a low local recurrence rate, a high rate of disease control, few complications, and a good or excellentf unctional result.