68例骨肿瘤致病理性骨折的治疗

目的:研究不同的外科治疗方法对骨肿瘤病理性骨折患者预后的影响.方法:自1995年6月～2002年10月共收治68例病理性骨折.引起病理性骨折的肿瘤中,转移癌27例(转移至四肢17例,脊柱8例,锁骨2例).原发恶性肿瘤20例(骨肉瘤13例,尤文氏肉瘤3例,软骨肉瘤2例,恶性纤维组织细胞瘤2例).良性肿瘤21例(骨巨细胞瘤12例,骨囊肿4例,内生软骨瘤及动脉瘤样骨囊肿各2例,纤维异样增殖症1例).通过回顾性分析研究,对其临床表现、诊断、治疗进行初步临床分析.结果:随访6个月～7.2年,转移癌中7例行局部广泛切除,假体置换,未见局部复发,功能良好.8例行病灶刮除,髓内针内固定,其中4例死亡,3例局部复发.13例骨肉瘤患者,9例对化疗敏感,行保肢手术,术后未见局部复发,预后良好,4例对化疗不敏感,行截肢术,术后均有肺转移.12例骨巨细胞瘤,7例行肿瘤广泛切除,假体置换,术后随访未见局部复发.5例行病灶刮除,骨水泥填充,其中3例复发.结论:对于转移癌、骨巨细胞瘤和一些良性肿瘤所致的病理性骨折,肿瘤的彻底切除和假体置换对于控制局部复发是有效的,并可获得良好的功能.对化疗敏感的骨肉瘤患者,即使骨折,经过化疗和适当处理后,也可行肿瘤的彻底切除和假体置换,也可获得良好的局部控制和降低肺转移发生率.

Surgical Treatment of Pathological Fracture Caused by Bone Tumor

Objective: To investigate the effects of various surgical treatments for pathological fractures caused by bone tumor. Materials: Between June in 1995 and October in 2002, 68 patients with pathological fracture caused by bone tumors were treated and their clinical findings and treatment were analyzed through retrospective method, with 38 males and 30 females. Among the tumors causing pathological fracture, 27 cases with metastases, 20 cases with primary malignant tumors, 21 cases with benign tumors. Primary healing of fracture was almost achieved after a follow-up which was less than 7.2 years. Results: In 7 cases with metastases, resection of mass was followed by construction prosthesis. 8 patients with metastases were treated with a intramedullary nail. 4 cases had died of the disease. 3 cases suffered from local relapse. 9 cases with osteosarcoma accepted limb sparing operation, 4 cases accepted amputation, all of which had no relapses with lung metastases in 4 patients. In 12 cases with giant cell tumor, 7 of which were treated with resection of mass followed by prosthesis construction, 5 of which were treated by curettage followed by cement filling, 3 cases suffered from local relapse. 6 patients with distant metastasis, 11 patients with local recurrence and dead of 8 patients were observed. Conclusion: For the pathological fracture caused by metastases? giant cell tumors and benign tumors, the local thorough resection of tumor and reconstruction is useful to reduce the relapse. If the osteosarcoma is sensitive to chemotherapy, the local thorough resection of tumor and reconstruction is also efficient to reduce the relapse and to prevent the lung metastasis even if the pathological fractures occur.