瘤段截除计划长度与最终截除长度的差异研究

目的：探讨骨肿瘤行瘤段截除时计划截除长度与实际截除长度的差异。方法对53例行瘤段截除的患者进行研究，骨肉瘤34例，骨巨细胞瘤5例，梭形细胞肉瘤5例，软骨肉瘤3例，骨转移癌3例，淋巴瘤1例，未分化多形性肉瘤1例，软组织肉瘤侵犯骨骼1例。肿瘤位于股骨下段29例，胫骨上段8例，肱骨上段7例，股骨近端5例，胫骨下段3例，肱骨远端1例。将实际截除长度与术前计划截除长度进行比较，将患者按不同部位分组，研究各组的差异大小。结果53例瘤段截除患者截除长度误差范围为-30～15 mm，95%可信区间为（2.0＆#177;7.7） mm。误差在＆#177;10 mm以内的40例，占75.5%，误差≤-10 mm的4例，占7.5%，误差≥10 mm的9例，占17%。股骨下段29例，误差为（2.9＆#177;6.7） mm，胫骨上段8例，误差为（3.8＆#177;5.1） mm，肱骨上段7例，误差为（3.6＆#177;8.0） mm，股骨近端5例，误差为（-0.2＆#177;6.0） mm，胫骨下段3例，误差为0 mm肱骨远端1例，误差为-30 mm。结论手术中通过找到术前设计的解剖标志及计划长度进行截骨准确性高，如果能避免引起误差的因素能使瘤段截除长度更加精准。

A comparison of planned and ifnal resection lengths in limb salvage surgery for bone tumors

Objective The resection length should be designed before the limb salvage surgery for bone tumors. To compare the differences of planned and final resection lengths in limb salvage surgery for bone tumors. Methods Fifty-three cases receiving limb salvage surgery were enrolled in the study, including 34 cases of osteosarcomas, 5 cases of giant cell tumors, 5 cases of spindle cell sarcomas, 3 cases of chondrosarcomas, 3 cases of bone metastases, 1 case of lymphoma, 1 case of undifferentiated pleomorphic sarcoma, and 1 case of soft tissue sarcoma with the bone involvement. The tumors were located in the distal femur （ n=29 ）, in the proximal tibia （ n=8 ）, in the proximal humerus （ n=7 ）, in the proximal femur （ n=5 ）, in the distal tibia （ n=3 ） and in the distal humerus （ n=1 ）. The planned and ifnal resection lengths were compared. The patients were classiifed according to the tumor location, and the differences were compared. Results The range of the length error was from-30 mm to 15 mm in the 53 cases. 95%conifdence interval （ CI ） was （ 2.0＆#177;7.7 ） mm. The length error was less than 10 mm in 40 cases （ 75.5%）, which was more than 10 mm in 9 cases （ 17%）, and only in 4 cases （ 7.5%） was less than-10 mm. The length error was （ 2.9＆#177;6.7 ） mm in 29 cases in the distal femur, （ 3.8＆#177;5.1 ） mm in 8 cases in the proximal tibia, （ 3.6＆#177;8.0 ） mm in 7 cases in the proximal humerus, （-0.2＆#177;6.0 ） mm in 5 cases in the proximal femur, 0 mm in 3 cases in the distal tibia and-30 mm in 1 case in the distal humerus. Conclusions The anatomical landmark and resection length are planned before the surgery. The accuracy of resection length is acceptable in this method. More precise resection could be achieved after avoiding the error-making factors.